Epstein et al's Exploring and Validating Patient Concerns-Relation to Prescribing for Depression

Epstein et al's Exploring and Validating Patient Concerns-Relation to Prescribing for Depression

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
ANNALS OF FAMILY MEDICINE WWW.ANNFAMMED.ORG VOL. 5, NO. 1 JANUARY/FEBRUARY 2007 21 Exploring and Validating Patient Concerns: Relation to Prescribing for Depression ABSTRACT PURPOSE This study examined moderating effects of physician communication behaviors on relationships between patient requests for antidepressant medica- tions and subsequent prescribing. METHODS We conducted a secondary analysis of a randomized trial. Primary care physicians (N = 152) each had 1 or 2 unannounced visits from standardized patients portraying the role of major depression or adjustment disorder. Each standardized patient made brand-speci± c, general, or no requests for antidepres- sants. We coded covert visit audio recordings for physicians’ exploration and validation of patient concerns (EVC). Effects of communication on prescribing (the main outcome) were evaluated using logistic regression analysis, accounting for clustering and for site, physician, and visit characteristics, and strati± ed by request type and standardized patient role. RESULTS In the absence of requests, high-EVC visits were associated with higher rates of prescribing of antidepressants for major depression. In low-EVC visits, prescribing was driven by patient requests (adjusted odds ratio [AOR] for request vs no request = 43.54, 95% con± dence interval [CI], 1.69-1,120.87; P ≤.005), not clinical indications (AOR for depression vs adjustment disorder = 1.82; 95% CI, 0.33-9.89; P = NS). In contrast, in high-EVC visits, prescribing was driven equally by requests (AOR = 4.02; 95% CI, 1.67-9.68; P ≤.005) and clini- cal indications (AOR = 4.70; 95% CI, 2.18-10.16; P ≤.005). More thorough his- tory taking of depression symptoms did not mediate these results. CONCLUSIONS Quality of care for depression is improved when patients partici- pate more actively in the encounter and when physicians explore and validate patient concerns. Communication interventions to improve quality of care should target both physician and patient communication behaviors. Cognitive mecha- nisms that link patient requests and EVC to quality of care warrant further study. Ann Fam Med 2007;5:21-28. DOI: 10.1370/afm.621. INTRODUCTION I n primary care settings, some patients with major depression who would beneF t from antidepressants do not receive medications, whereas others with questionable indications do. 1 We recently reported that when patients request an antidepressant medication, prescribing increases regardless of clinical indications. 1 Because depression is com- mon 2 and associated with considerable morbidity and cost, 3-6 and because treatment is effective, 7,8 these F ndings have important health and quality of care implications. Patterns of underuse and overuse of medical interven- tions have been noted for other conditions as well. 9-12 Poorly understood communication factors appear to underlie the vari- ability in use of antidepressants. We undertook this analysis to gain under- standing of the relationship between patient-physician communication and concurrent prescribing decisions. In particular, we were interested in the process of communication, rather than just the content. One feature of
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 04/13/2010 for the course PSYCH 101 taught by Professor Gabbart during the Spring '08 term at Union College.

Page1 / 8

Epstein et al's Exploring and Validating Patient Concerns-Relation to Prescribing for Depression

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online