Attitudes, Knowledge, and Behavior of Family Physicians Regarding Depression in Late Life

Gallo, Joseph J.; Ryan, Stephen D.; Ford, Daniel E.

doi:10.1001/archfami.8.3.249

Cited by 55 publications

(53 citation statements)

References 24 publications

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“…Our sample size was relatively small compared with other surveys. 4,9,13 Although our response rate for the survey was high, clinicians who returned a survey instrument might have differed from others in important ways. Despite limitations, our results about the preference of primary care clinicians for integrated rather than enhanced referral care deserve attention because our study of clinician attitudes differs in several important ways from other surveys carried out in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we have focused on the mental health care of older adults, in contrast with other studies that have not considered the specifi c needs of older persons. [5][6][7] Most importantly, unlike studies that elicit opinions of primary care clinicians, 5,6,[8][9][10] we specifi cally asked these clinicians about the effect of the integrated and enhanced referral models on the care of patients for whom the participating clinicians had clinical responsibility. No other study has asked clinicians about the preferences for new models of mental health care for older persons who were actually under their care.…”

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confidence: 99%

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Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

Gallo

Zubritsky

Maxwell

et al. 2004

The Annals of Family Medicine

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108

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BACKGROUND Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions. METHODThe Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site.RESULTS Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care.CONCLUSIONS Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care. INTRODUCTIONT o address patient, physician, and health system barriers to adequate care of depression and other mental health conditions of late life, innovative models are being tested to enhance the recognition and management of mental health problems in primary care.1-3 The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a multisite effectiveness trial designed to assess the use of a mental health and substance abuse (MH/SA) specialist co-located in the primary care practice to enhance treatment (the integrated care model) and the use of direct referral to specialty care (the enhanced referral model) for older adults with depression, anxiety, or alcohol use problems. We asked the clinicians to offer their perspectives on the specifi c interventions tested in PRISM-E. Given the heterogeneity of how primary care clinicians manage depression, 4 it is important to be aware of systems of care that clinicians Our study differs from previous studies of attitudes of primary care clinicians regarding MH/SA treatment given to patients in primary care. First, most studies have focused on depression, 5-7 whereas we were able to examine several conditions that affect older adults in relation to primary health care. Second, we have focused on the mental health care of older adults, in contrast with other studies that have not considered the specifi c needs of older persons. [5][6][7] Most importantly, unlike stu...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

Gallo

Zubritsky

Maxwell

et al. 2004

The Annals of Family Medicine

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108

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“…Most share a similar emphasis on accurate diagnosis and the provision of technical treatmentsspecifically, antidepressant prescription and mental health referral. 5,6 Although most primary care physicians are familiar with the guidelines, [7][8][9] overall physician adherence is poor.…”

Section: Introductionmentioning

confidence: 99%

“…Data suggest that physicians are reluctant to prescribe antidepressants to patients with symptoms that seem attributable to life problems and difficulties. 8,13,17 In such cases, physicians may base their treatment decisions on informal algorithms derived from common sense or clinical experience. 18 Since the conversations between doctors and patients about depression have been little investigated,…”

Section: Introductionmentioning

confidence: 99%

What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes

et al. 2012

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“…Psychiatric symptoms can easily be mistaken as physical symptoms of aging or preexisting disease (e.g., vascular disease [Alexopoulos et al, 1997]). In some cases, certain disorders such as depression might be considered to be a "normal" experience for older adults because of aging (Gallo, Ryan, & Ford, 1999;Laidlaw et al, 2003). Life stressors (such as caregiving for one's parent and child at the same time) also decrease the likelihood of baby boomers finding the time to engage in mental-health, help-seeking behaviors (Lehmann, 2003).…”

Section: Background About the Mental Health Treatment Of Older Adultsmentioning

confidence: 99%

Deconstructing Demons: The Case of Geoffrey

Mohlman

Cedeno

Price

et al. 2008

PCSP

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Research in late life mental health has not kept pace with the rapidly aging population of the U.S. Older adults (over age 65), more specifically the "baby boomer" cohort, are likely to pose unique challenges to mental health care providers. This report describes the case of Geoffrey, a 66-yearold African American male who presented with a complex range of psychiatric conditions (e.g., major depressive disorder, social anxiety disorder, and a history of polysubstance dependence), and challenging life circumstances (e.g., limited financial and social resources, and poorly controlled medical illness). Because Geoffrey also evidenced impairment in several cognitive domains (attention, memory, executive functions), a combined intervention of executive skills training (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) and cognitive behavior therapy (CBT) was selected. Furthermore, because time for conducting therapy was limited (fourteen, 90-minute sessions over a ten-week period), a "transdiagnostic" approach was taken to maximize efficiency. Results suggest the utility of augmented, transdiagnostic therapies to achieve optimal response with older clients. Although Geoffrey's intervention progressed well, an event occurring late in treatment changed the course of therapy and led to an unexpected outcome. Several noteworthy aspects of the intervention, including the relevance of Geoffrey's case to the current aging trend in the U.S., the use of a combined transdiagnostic intervention, and aspects of the therapy process are discussed throughout.

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Attitudes, Knowledge, and Behavior of Family Physicians Regarding Depression in Late Life

Abstract: Depression in late life remains a difficult clinical challenge for primary care physicians. These findings are particularly relevant in the face of recent efforts to increase collaboration between primary care physicians and mental health professionals.

Cited by 55 publications

References 24 publications

Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes

Deconstructing Demons: The Case of Geoffrey

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