OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed.
OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed.
Authors: Laura N Gitlin; Lynn Fields Harris; Megan C McCoy; Nancy L Chernett; Laura T Pizzi; Eric Jutkowitz; Edward Hess; Walter W Hauck Journal: Ann Intern Med Date: 2013-08-20 Impact factor: 25.391
Authors: Ming Tai-Seale; Mark E Kunik; Alexandra Shepherd; JoAnn Kirchner; Aruna Gottumukkala Journal: Popul Health Manag Date: 2010-11-19 Impact factor: 2.459
Authors: Gregory Luke Larkin; Annette L Beautrais; Anthony Spirito; Barbara M Kirrane; Melanie J Lippmann; David P Milzman Journal: Acad Emerg Med Date: 2009-11 Impact factor: 3.451