Exploring and validating patient concerns

Relation to prescribing for depression

Ronald M. Epstein, Cleveland G. Shields, Peter Franks, Sean C. Meldrum, Mitchell Feldman, Richard L Kravitz

Research output: Contribution to journalArticle

34 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)21-28
Number of pages8
JournalAnnals of Family Medicine
Volume5
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

Fingerprint

Depression
Quality of Health Care
Physicians
Odds Ratio
Communication
Confidence Intervals
Antidepressive Agents
Adjustment Disorders
Primary Care Physicians
Cluster Analysis
Logistic Models
Regression Analysis

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 journalArticle

Epstein, Ronald M. ; Shields, Cleveland G. ; Franks, Peter ; Meldrum, Sean C. ; Feldman, Mitchell ; Kravitz, Richard L. / Exploring and validating patient concerns : Relation to prescribing for depression. In: Annals of Family Medicine. 2007 ; Vol. 5, No. 1. pp. 21-28.
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