PRIMARY-CARE PHYSICIANS MEDICAL DECISION-MAKING FOR LATE-LIFE DEPRESSION

OBJECTIVE: To describe primary care physicians' clinical decision maki ng regarding late-life depression. DESIGN: Longitudinal collection of data regarding physicians' clinical assessments and the volume and con tent of patients' ambulatory visits as part of a randomized clinical t rial of a physician-targeted intervention to improve the treatment of late-life depression. SETTING: Academic primary care group practice. P ATIENTS/PARTICIPANTS: One-hundred and eleven primary care physicians w ho completed a structured questionnaire to describe their clinical ass essments immediately following their evaluations of 222 elderly patien ts who had reported symptoms of depression on screening questionnaires . INTERVENTIONS: Intervention physicians were provided with their pati ent's score on the Hamilton Depression rating scale (HAM-D) and patien t-specific treatment recommendations prior to completing the questionn aire regarding their clinical assessment. MAIN RESULTS: Those physicia ns not provided HAM-D scores were just as likely to rate their patient s as depressed, as determined by specific query of these physicians re garding their clinical assessments, A physician's clinical rating of l ikely depression did not consistently result in the formulation of tre atment intentions or actions. Treatment intentions and actions were fa cilitated by provision of treatment algorithms, but treatment was rece ived by fewer than half of the patients whom physicians intended to tr eat. Barriers to treatment appear to include both physician and patien t doubts about treatment benefits. CONCLUSIONS: Lack of recognition of depressive symptoms did not appear to be the primary barrier to treat ment. Recognition of symptoms and access to treatment algorithms did n ot consistently result in progression to subsequent stages in treatmen t decision making. More research is needed to determine how patients a nd physicians weigh the potential risks and benefits of treatment and how accurately they make these judgments.