Counseling for depression by primary care providers

Objective: Primary care providers (PCPs) deliver a significant amount of de pression care, yet little is known about the content of clinical encounters with depressed patients. We describe the extent to which PCP's encounters with depressed and non-depressed patients involve psychotherapeutic counsel ing relative to other types of counseling during primary care visits. Metho d: Cross-sectional evaluation of audiotaped office visits between October 1 997 and September 1998 with 154 patients of 27 PCPs at three Veterans' Heal th Administration clinics in California. Using the Roter Interaction Analys is System, we coded conversation into mutually exclusive talk categories an d developed specific measures of depression counseling coded for sequences of depression talk. Analysis of variance and covariance was used to evaluat e differences in counseling by depression type adjusted for encounter lengt h, previous depression treatment, patient characteristics, and provider clu stering. Results: PCPs delivered significantly more depression care (assess ed using coded audiotapes of patient visits) to their patients with major d epression compared with patients who had no depression or symptoms but no d isorder. However, counseling using psychotherapeutic techniques did not dif fer by depression level and was equivalent for patients with major depressi on and subthreshold relative to non-depressed. Encounters with patients who had major depression included more talk about depression, devoted more tim e to discussing depression, and included more depression talk per minute. P CP encounters with depressed patients also included less biomedical talk co mpared to other groups. Conclusions. Findings suggest that PCPs do provide depression counseling to their patients who need it the most. Whether couns eling is associated with appropriate treatment and subsequent outcomes will require additional research.