Do patient requests for antidepressants enhance or hinder physicians' evaluation of depression? A randomized controlled trial

Mitchell D. Feldman, Peter Franks, Ronald M. Epstein, Carol E. Franz, Richard L Kravitz

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: We sought to ascertain whether patients' requests for antidepressants affect visit duration or history taking by primary care physicians (PCPs) for patients with depressive symptoms and a coexisting musculoskeletal disorder and to determine whether more thorough history taking is associated with diagnostic accuracy or with provision of minimally acceptable initial care for major depression. DESIGN: This was a randomized trial using standardized patients (SPs). Six roles involved 2 conditions (major depression and adjustment disorder, both with coexisting musculoskeletal conditions) and 3 patient request types (brand-specific, general, or none). We conducted the study in 152 PCP offices in Northern California and Rochester, New York. Physicians were assigned randomly to see 2 SPs with depression/wrist pain or adjustment disorder/back pain. MAIN OUTCOME MEASURES: Physician history-taking for depression and the musculoskeletal condition; depression diagnosis in the medical record; antidepressant prescriptions/samples; referral/follow-up recommendations; visit duration; and provision of minimally acceptable initial depression care. RESULTS: General antidepressant requests were associated with more depression history-taking (Adjusted Parameter Estimate = 0.80 more questions of 10 (95% confidence interval = 0.31-1.29, P < 0.001); brand-specific requests were marginally associated with more depression history-taking (Adjusted Parameter Estimate = 0.45, 95% confidence interval = -0.04-0.93, P = 0.07). Antidepressant medication requests were not related to musculo-skeletal question asking (P > 0.3) or visit length (P > 0.8). Depression history taking was directly associated with the likelihood of a chart diagnosis of depression and the provision of minimally acceptable initial depression care. CONCLUSION: General antidepressant requests increase depression history taking, including screening for suicide. Patients' requests for medication do not appear to short-circuit history taking for depression or distract the physician's attention from coexisting musculoskeletal conditions.

Original languageEnglish (US)
Pages (from-to)1107-1113
Number of pages7
JournalMedical Care
Volume44
Issue number12
DOIs
StatePublished - Dec 2006

Fingerprint

Antidepressive Agents
Randomized Controlled Trials
physician
Depression
Physicians
evaluation
Adjustment Disorders
Primary Care Physicians
pain
medication
Physicians' Offices
Somatoform Disorders
Back Pain
Wrist
suicide
Suicide
Medical Records
diagnostic
Prescriptions
confidence

Keywords

  • Depression
  • Doctor-patient communication
  • Patient requests

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Do patient requests for antidepressants enhance or hinder physicians' evaluation of depression? A randomized controlled trial. / Feldman, Mitchell D.; Franks, Peter; Epstein, Ronald M.; Franz, Carol E.; Kravitz, Richard L.

In: Medical Care, Vol. 44, No. 12, 12.2006, p. 1107-1113.

Research output: Contribution to journalArticle

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