General Practitioner Diagnosis of Depression and Dementia in the Elderly: Can Academic Detailing Make a Difference?

Pond, Claire; Mant, Andrea; Kehoe, Linda; Hewitt, Helen; Brodaty, Henry

doi:10.1093/fampra/11.2.141

Cited by 54 publications

(37 citation statements)

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“…Nineteen studies recruited older patients and examined defined late-life depression, but of these only 12 considered both sensitivity and specificity [34,35,36,37,38,39,40,41,42,43,44,45]. Twenty-seven recruited younger adults and of these 12 examined both sensitivity and specificity [46,47,48,49,50,51,52,53,54,55,56].…”

Section: Resultsmentioning

confidence: 99%

“…The median number of depressed patients per study was 293.5 (SD = 750.2). The criterion methods of establishing depression consisted of a structured or semi-structured interview in 13 studies [34,35,36,37,38,39,46,47,48,49,50,57,58] and severity scales in 18 [40,41,42,43,44,45,51,52,53,54,55,56,59,60,61,62,63]. Of the 13 interview methods, 5 used a DSM-based definition of depression, 6 an ICD-10 definition, 1 the Schedule for Affective Disorder and Schizophrenia and 1 the Short Comprehensive Assessment and Referral Evaluation Interview.…”

Section: Resultsmentioning

confidence: 99%

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Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Mitchell

Rao

Vaze

2010

Psychother Psychosom

125

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Background: There is long-standing concern regarding poor recognition of depression in primary care, especially in older people. Methods: Studies that examined the unassisted (clinical) ability of general practitioners (GPs; primary care physicians) to identify depression were divided into those of older adults, younger adults and mixed populations. Data were extracted by 3 reviewers independently and pooled using a Bayesian meta-analysis. Results: We identified 31 valid studies that examined both sensitivity and specificity (or rule-in and rule-out accuracy), involving 52,513 individuals. Twelve studies recruited older individuals, 12 recruited younger adults and 7 recruited both younger and older adults (mixed populations). In the most robust studies the point prevalence of depression in late life was 13.2% (95% CI = 7.9–19.6). GPs were able to correctly identify 47.3% of the late-life depressions and 78.6% of the non-cases (71.0% overall accuracy). In younger adults GPs were able to identify 39.7% of the mid-life depressions and 85.1% of the non-depressed (77.8% overall accuracy). In mixed aged groups GPs we able to correctly identify 46.6% of the depressed individuals and 86.2% of the non-depressed (79.6% overall accuracy). The overall fraction correctly identified was significantly lower in older compared with younger adults. Correcting for differences in prevalence showed a statistically lower rule-in performance for older compared with younger adults. There was no difference in ability to identify non-depressed (healthy) individuals by age. Conclusions: In clinical practice GPs appear to be less successful in identifying depression in older people than in younger adults, however there have been few head-to-head studies stratified by age from one centre.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Mitchell

Rao

Vaze

2010

Psychother Psychosom

125

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“…There were four studies from Australia, [42][43][44][45] four from Italy, [46][47][48][49] six from the Netherlands, [50][51][52][53][54][55] three from the UK, [56][57][58] and eight from the US, [59][60][61][62][63][64][65][66] all reporting diagnostic sensitivity (Table 1).…”

Section: Study Description and Methodsmentioning

confidence: 99%

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Mitchell¹,

Rao²,

Vaze³

2011

Br J Gen Pract

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A meta-analysis of unassisted clinical diagnoses against semi-structured interviews. MethodA systematic literature search, critical appraisal, and pooled analysis were conducted and 25 international studies were identified involving 8917 individuals. A minimum of three independent studies per country were required to aid extrapolation. ResultsClinicians in the Netherlands performed best at case finding (the ability to rule in cases of depression with minimal false positives) (AUC+ 0.735) and this was statistically significantly better than the ability of clinicians in Australia (AUC+ 0.622) and the US (AUC+ 0.653), who were the worst performers. Clinicians from Italy had intermediate case-finding abilities. Regarding screening (the ability to rule out cases of no depression with minimal false negatives) there were no strong differences. Looking at overall accuracy, primary care physicians in Italy and the Netherlands were most successful in their diagnoses and physicians from the US and Australia least successful (83.5%, 81.9%, 74.3%, and 67.0%, respectively). GPs in the UK appeared to have the lowest ability to detect depression, as a proportion of all cases of depression (45.6%; 95% CI = 27.7% to 64.2%). Several factors influenced detection accuracy including: collecting data on clinical outcomes; routinely comparing the clinical performance of staff; working in small practices; and having long waits to see a specialist. ConclusionAssuming these differences are representative, there appear to be international variations in the ability of primary care physicians to diagnose depression, but little differences in screening success. These might be explained by organisational factors.

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“…The general practitioner (GP) and the primary health care team have the greatest opportunities to detect early cases of dementia through their long-standing contacts with the patient and family [9,10]. However, there are indications that it is difficult to diagnose dementia and to differentiate it from normal aging and other diseases such as depression and drug sideeffects in the primary care setting [11][12][13][14][15].…”

mentioning

confidence: 99%

Detection of Dementia in Primary Care: The Linköping Study

Ólafsdóttir

Skoog²,

Marcusson³

2000

Dement Geriatr Cogn Disord

115

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We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor’s consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.

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General Practitioner Diagnosis of Depression and Dementia in the Elderly: Can Academic Detailing Make a Difference?

Cited by 54 publications

References 0 publications

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

Detection of Dementia in Primary Care: The Linköping Study

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