Diagnosing depression and prescribing antidepressants by primary care physicians: the impact of practice style variations

Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, USA.
Mental Health Services Research 07/2002; 4(2):109-18. DOI: 10.1023/A:1015204401225
Source: PubMed

ABSTRACT This study examined variations in the diagnosis of depressive disorders and prescription of antidepressant medications in primary care and the contribution of the physicians' practice styles to these variations. The analyses were based on visits to a representative sample of the U.S. office-based primary care physicians from the 1997 and 1998 National Ambulatory Medical Care Survey. In this sample, the propensities to give a diagnosis of depressive disorder and to prescribe antidepressants were operationalized as propensity variables. The association of these variables, obtained from a randomly selected subsample of visits to each physician, with the diagnoses and treatments of the other patients seen by the same physicians was examined. The results revealed considerable variations across practices in the percentages of patients who received diagnoses of depressive disorders (0-25%) and prescriptions for antidepressant medications (0-38%). Furthermore, the physicians' propensities to diagnose depressive disorders or to prescribe antidepressants were significantly associated with the diagnosis and treatment of individual patients. The large variations in diagnosis and treatment of depressive disorders and the significant impact of practice style variables on these variations highlight the need for implementation of uniform practice guidelines for diagnosis and treatment of depressive disorders in primary care settings.

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    • "Consequently, when GPs see depressed patients, they often have to deal with complicated cases. The ways GPs handle these patients have been criticised because of deficient identification and insufficient treatment of the depressive disorders [7-11]. "
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    ABSTRACT: The way GPs work does not appear to be adapted to the needs of depressive patients. Therefore we wanted to examine Swedish GPs' conceptions of depressive disorders and their treatment and GPs' ideas of factors that may influence their manner of work with depressive patients. A postal questionnaire to a stratified sample of 617 Swedish GPs. Most respondents assumed antidepressive drugs effective and did not assume that psychotherapy can replace drugs in depression treatment though many of them looked at psychotherapy as an essential complement. Nearly all respondents thought that clinical experiences had great importance in decision situations, but patients' own preferences and official clinical guidelines were also regarded as essential. As influences on their work, almost all surveyed GPs regarded experiences from general practice very important, and a majority also emphasised experiences from private life. Courses arranged by pharmaceutical companies were seen as essential sources of knowledge. A majority thought that psychiatrists did not provide sufficient help, while most respondents perceived they were well backed up by colleagues. GPs tend to emphasize experiences, both from clinical work and private life, and overlook influences of collegial dealings and ongoing CME as well as the effects of the pharmaceutical companies' marketing activities. Many GPs appear to need more evidence based knowledge about depressive disorders. Interventions to improve depression management have to be supporting and interactive, and should be combined with organisational reforms to improve co-operation with psychiatrists.
    BMC Family Practice 06/2005; 6(1):21. DOI:10.1186/1471-2296-6-21 · 1.67 Impact Factor
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    ABSTRACT: To examine how local sales levels of antidepressive agents (ADs) correlated with GPs' conceptions of depressive disorders and of factors that may influence their work with depressed patients. A postal questionnaire survey to GPs requesting their conceptions of depression and their opinions of additional factors that may influence their work with depressed patients. GPs' conceptions and opinions were compared with local sales rates of ADs. Three selected groups of Swedish municipalities: those with the highest, the average, and the lowest sales rates of ADs. All 535 GPs who worked in the selected municipalities. Spearman rank correlations for responses to the questionnaire with the sales levels of ADs. High sales levels correlated positively with a high evaluation of ADs' effectiveness in depression and panic disorders and were inversely correlated with the degree of appreciation of psychotherapy-based treatments. High sales levels were also associated with a high evaluation of GPs' own clinical and private experience, with a positive appreciation of the work with depressed patients and with a high level of participation in the pharmaceutical companies' activities. The demonstrated statistical correlations were not particularly strong and included less than half of the items. This ecological study confirms a number of statistical associations between sales levels of ADs and GPs' prevailing conceptions of factors related to depression. However, their explanatory value of the geographical sale variation appears limited. To further clarify this variation, studies employing information on individual GPs' conceptions and prescribing are required.
    Scandinavian Journal of Primary Health Care 04/2005; 23(1):11-7. DOI:10.1080/02813430510015250 · 1.30 Impact Factor
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