PHYSICIAN VS PATIENT INITIATION OF PSYCHOTROPIC PRESCRIBING IN PRIMARY-CARE SETTINGS - A CONTENT-ANALYSIS OF AUDIOTAPES

The primary goals of this study were to examine: (1) whether patients were involved actively in initiating the prescribing of psychotropic m edications during interactions with their primary care physicians and (2) what variables influenced patient vs physician initiation of psych otropic prescribing. An analysis of 508 audiotapes of physician-patien t interactions and interviews with each patient and physician from 11 different ambulatory care settings was conducted. Of 508 patients, 17% (n = 88) received prescriptions for one or more psychotropic medicati ons. Forty-seven percent of repeat psychotropic prescriptions and 20% of new psychotropic prescriptions were initiated by patients. Logistic regression techniques showed that patients with higher incomes were m ore likely than their physicians to initiate psychotropic prescribing, whereas physicians were more likely to initiate psychotropic prescrib ing with lower income patients (P < 0.001). Patients who had more prev ious visits to their physician were as likely as their physicians to i nitiate psychotropic prescribing, whereas physicians were more likely to initiate psychotropic prescribing with patients who had been to see them fewer times in the past (P < 0.05). Copyright (C) 1997 Elsevier Science Ltd