Abstract
PURPOSE: This study examined moderating effects of physician communication behaviors on relationships between patient requests for antidepressant medications and subsequent prescribing. METHODS: We conducted a secondary analysis of a randomized trial. Primary care physicians (N = 152) each had 1 or 2 unannounced visits from standardized patients portraying the role of major depression or adjustment disorder. Each standardized patient made brand-specific, general, or no requests for antidepressants. We coded covert visit audio recordings for physicians' exploration and validation of patient concerns (EVC). Effects of communication on prescribing (the main outcome) were evaluated using logistic regression analysis, accounting for clustering and for site, physician, and visit characteristics, and stratified by request type and standardized patient role. RESULTS: In the absence of requests, high-EVC visits were associated with higher rates of prescribing of antidepressants for major depression. In low-EVC visits, prescribing was driven by patient requests (adjusted odds ratio [AOR] for request vs no request = 43.54, 95% confidence interval [CI], 1.69-1,120.87; P ≤.005), not clinical indications (AOR for depression vs adjustment disorder = 1.82; 95% CI, 0.33-9.89; P = NS). In contrast, in high-EVC visits, prescribing was driven equally by requests (AOR = 4.02; 95% CI, 1.67-9.68; P ≤.005) and clinical indications (AOR = 4.70; 95% CI, 2.18-10.16; P ≤.005). More thorough history taking of depression symptoms did not mediate these results. CONCLUSIONS: Quality of care for depression is improved when patients participate more actively in the encounter and when physicians explore and validate patient concerns. Communication interventions to improve quality of care should target both physician and patient communication behaviors. Cognitive mechanisms that link patient requests and EVC to quality of care warrant further study.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 21-28 |
| Number of pages | 8 |
| Journal | Annals of Family Medicine |
| Volume | 5 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2007 |
| Externally published | Yes |
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Keywords
- Adjustment disorders
- Advertising
- Antidepressive agents
- Depression
- Family practice
- Mass media
- Patient-centered care
- Patients
- Physician's practice patterns
- Physician-patient relations
- Prescriptions, drug
- Primary care
- Quality of health care
ASJC Scopus subject areas
- Family Practice
Cite this
Exploring and validating patient concerns : Relation to prescribing for depression. / Epstein, Ronald M.; Shields, Cleveland G.; Franks, Peter; Meldrum, Sean C.; Feldman, Mitchell; Kravitz, Richard L.
In: Annals of Family Medicine, Vol. 5, No. 1, 01.2007, p. 21-28.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Exploring and validating patient concerns
T2 - Relation to prescribing for depression
AU - Epstein, Ronald M.
AU - Shields, Cleveland G.
AU - Franks, Peter
AU - Meldrum, Sean C.
AU - Feldman, Mitchell
AU - Kravitz, Richard L
PY - 2007/1
Y1 - 2007/1
N2 - PURPOSE: This study examined moderating effects of physician communication behaviors on relationships between patient requests for antidepressant medications and subsequent prescribing. METHODS: We conducted a secondary analysis of a randomized trial. Primary care physicians (N = 152) each had 1 or 2 unannounced visits from standardized patients portraying the role of major depression or adjustment disorder. Each standardized patient made brand-specific, general, or no requests for antidepressants. We coded covert visit audio recordings for physicians' exploration and validation of patient concerns (EVC). Effects of communication on prescribing (the main outcome) were evaluated using logistic regression analysis, accounting for clustering and for site, physician, and visit characteristics, and stratified by request type and standardized patient role. RESULTS: In the absence of requests, high-EVC visits were associated with higher rates of prescribing of antidepressants for major depression. In low-EVC visits, prescribing was driven by patient requests (adjusted odds ratio [AOR] for request vs no request = 43.54, 95% confidence interval [CI], 1.69-1,120.87; P ≤.005), not clinical indications (AOR for depression vs adjustment disorder = 1.82; 95% CI, 0.33-9.89; P = NS). In contrast, in high-EVC visits, prescribing was driven equally by requests (AOR = 4.02; 95% CI, 1.67-9.68; P ≤.005) and clinical indications (AOR = 4.70; 95% CI, 2.18-10.16; P ≤.005). More thorough history taking of depression symptoms did not mediate these results. CONCLUSIONS: Quality of care for depression is improved when patients participate more actively in the encounter and when physicians explore and validate patient concerns. Communication interventions to improve quality of care should target both physician and patient communication behaviors. Cognitive mechanisms that link patient requests and EVC to quality of care warrant further study.
AB - PURPOSE: This study examined moderating effects of physician communication behaviors on relationships between patient requests for antidepressant medications and subsequent prescribing. METHODS: We conducted a secondary analysis of a randomized trial. Primary care physicians (N = 152) each had 1 or 2 unannounced visits from standardized patients portraying the role of major depression or adjustment disorder. Each standardized patient made brand-specific, general, or no requests for antidepressants. We coded covert visit audio recordings for physicians' exploration and validation of patient concerns (EVC). Effects of communication on prescribing (the main outcome) were evaluated using logistic regression analysis, accounting for clustering and for site, physician, and visit characteristics, and stratified by request type and standardized patient role. RESULTS: In the absence of requests, high-EVC visits were associated with higher rates of prescribing of antidepressants for major depression. In low-EVC visits, prescribing was driven by patient requests (adjusted odds ratio [AOR] for request vs no request = 43.54, 95% confidence interval [CI], 1.69-1,120.87; P ≤.005), not clinical indications (AOR for depression vs adjustment disorder = 1.82; 95% CI, 0.33-9.89; P = NS). In contrast, in high-EVC visits, prescribing was driven equally by requests (AOR = 4.02; 95% CI, 1.67-9.68; P ≤.005) and clinical indications (AOR = 4.70; 95% CI, 2.18-10.16; P ≤.005). More thorough history taking of depression symptoms did not mediate these results. CONCLUSIONS: Quality of care for depression is improved when patients participate more actively in the encounter and when physicians explore and validate patient concerns. Communication interventions to improve quality of care should target both physician and patient communication behaviors. Cognitive mechanisms that link patient requests and EVC to quality of care warrant further study.
KW - Adjustment disorders
KW - Advertising
KW - Antidepressive agents
KW - Depression
KW - Family practice
KW - Mass media
KW - Patient-centered care
KW - Patients
KW - Physician's practice patterns
KW - Physician-patient relations
KW - Prescriptions, drug
KW - Primary care
KW - Quality of health care
UR - http://www.scopus.com/inward/record.url?scp=33846689279&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33846689279&partnerID=8YFLogxK
U2 - 10.1370/afm.621
DO - 10.1370/afm.621
M3 - Article
VL - 5
SP - 21
EP - 28
JO - Annals of Family Medicine
JF - Annals of Family Medicine
SN - 1544-1709
IS - 1
ER -