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A total of 298 visits to 152 internists and family physicians in four health care organizations in California and New York took place during the study. The physicians did not know that their appointments were with standardized patients as opposed to real patients, but they did give their permission to be part of the study and were told that the visits were audio recorded and would be examined for content following each interaction.

The researchers studied physician history-taking patterns, examining whether a diagnosis of depression was placed in the medical record, the length of the visit, and whether minimally acceptable initial depression care had been provided. Minimally acceptable depression care is defined as any combination of the following steps -- prescribing an antidepressant prescription, providing a mental health referral, or giving a follow-up visit within two weeks of the initial visit.

Study findings showed that requests for general antidepressant medication were associated with an increase in depression-specific history-taking by physicians. On average, physicians asked 0.80 more questions than if no request was made, while brand-specific requests were only marginally associated with an increase in questions (0.45 more questions).

"It may be that physicians see a request for a general medication as an invitation for further discussion about the diagnosis and treatment options, whereas brand-specific requests may be heard as a consumer demand for medical services in response to emotional persuasion rather than high-quality information," said Feldman.

A greater amount of time spent by the physician in depression history-taking was also directly associated with both the likelihood of a diagnosis of depression being made i
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Contact: Vanessa deGier
vdegier@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
8-Dec-2006