Family Medicine and Internal Medicine Physicians’ Attitudes and Beliefs About Depression: Implications for Treatment Decisions.

Family Medicine and Internal Medicine Physicians’ Attitudes and Beliefs About Depression: Implications for Treatment Decisions.

J Prim Care Community Health. 2011 Apr 1; 2(2): 107-115
Hooper LM, Epstein SA, Qu L, Hannah NJ

Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians. They examined how physicians’ attitudes (eg, feeling positively or negatively about treating depression in their patients), physicians’ beliefs (eg, beliefs about what their patients think and prefer in terms of depression care), and demographic characteristics (independent variables) predicted optimal depression care (dependent variable). Using logistical regression analyses, they identified differences in treatment decisions between family and internal medicine physicians. Physicians’ specialty and race (family physicians and white physicians were more likely to prescribe a medication) were unique determinants of whether the physician treated depression by prescribing medication; physicians’ specialty and race (family physicians and nonwhite physicians were more likely to provide office-based counseling) were unique determinants of whether the physician treated depression by providing office-based counseling; physicians’ beliefs about depression care and physician age were unique statistically significant determinants of whether the physician treated depression by providing a referral to a mental health specialist. These findings help clarify how physicians’ specialty and beliefs about depression care influence treatment. In addition, the results in this study suggest that there are differences between family and internal medicine physicians in terms of their practice patterns and beliefs in types of treatment that patients would be willing to receive. Implications for future research on primary care depression treatment are discussed. HubMed – depression


Increased Anxiety and Length of Treatment Associated With Depressed Patients Who are Readmitted to Collaborative Care.

J Prim Care Community Health. 2011 Apr 1; 2(2): 82-86
Angstman KB, Maclaughlin KL, Williams MD, Rasmussen NH, Dejesus RS

In 2008, the Institute for Clinical Systems Improvement (ICSI) in Minnesota implemented a model of collaborative care management (CCM) for treatment of depression in primary care. This resulted in significant improvements on both clinical response and remission over usual care, although an increase in utilization metrics has been observed. Mental health comorbidities have previously been significantly associated with an increased likelihood of not responding to initial treatment. This retrospective study hypothesized that patients with mental health comorbidities are more likely to be associated with patients who were readmitted into CCM with recurrent depression. A total of 145 patients who had completed CCM were studied; of these, 32 were diagnosed with recurrent depression and were readmitted to CCM, and 113 were in remission for at least 4 months. There were no statistically significant demographic differences between the 2 groups. The initial screening GAD-7 score for anxiety was significantly increased in the readmission group (12.81 vs 9.20, P = .001) as was the average length of treatment from initial diagnosis to remission (168.09 vs 120.99 days, P = .002). All other initial screening tests were not different between the groups. When controlling for the independent variables by multiple logistic regression, the odds ratio for GAD-7 was 1.1156 (CI = 1.0.192 to 1.2212, P = .0177) and for days of treatment in CCM was 1.0123 (CI = 1.0041 to 1.0206, P = .0033). Patients who are readmitted to CCM for recurrent depression have a statistically increased risk of associated anxiety and a longer treatment course than those who have remained in remission for at least 4 months. HubMed – depression


Prevalence and Comorbidities of Somatoform Disorders in a Rural California Outpatient Psychiatric Clinic.

J Prim Care Community Health. 2011 Jan 1; 2(1): 54-59
Ng B, Tomfohr LM, Camacho A, Dimsdale JE

This study examines the prevalence and comorbidities of somatoform disorders in a rural setting with a diverse ethnic population.A retrospective chart review was conducted of active psychiatric outpatients in a clinic located in a rural community. Data abstracted included demographic variables, multi-axial diagnoses (DSM-IV-TR), length of treatment, psychotropic medications, and number of medications discontinued because of side effects. Improvement in level of function with treatment was measured by change in global assessment of functioning (GAF) scores.Of 737 records reviewed, 37 (5%) contained a diagnosis of somatoform disorder. The most common comorbidities in the somatoform group were depression (P < .01), hypertension (P < .01), and arthritis (P < .05). The somatoform group was significantly more likely to have a chronic medical illness (P < .01) and history of surgeries (P < .05). The somatoform group patients' ?GAF was one fourth the ?GAF scores in all other psychiatric outpatients (1.41 vs 6.79, P < .01). The somatoform group changed medications more often because of side effects (1.35 times vs 0.71 times, P < .01), received a greater number of psychotropic medications (2.05 vs 1.62, P < .05), and was more likely to be taking an antidepressant (P < .05) than the nonsomatoform group.Somatoform disorder patients had a higher prevalence of depression, chronic medical conditions, and surgeries. They responded less favorably to treatment when compared to patients without a somatoform disorder, and manifested a decreased tolerance to medication side effects. Female gender, fewer years of education, and Latino ethnicity did not increase the probability of having a somatoform disorder. HubMed – depression


Pain Management and the Primary Care Encounter: Opportunities For Quality Improvement.

J Prim Care Community Health. 2011 Jan 1; 2(1): 37-44
Gannon M, Qaseem A, Snow V, Snooks Q

The purpose of this pilot study was to create a comprehensive pain management educational toolkit for the primary care physician that offers guidance on current standards of care and quality improvement techniques to help curb educational and quality gaps in managing patients with pain.Pain often goes undetected in the primary care encounter, and when acknowledged, is often undertreated.This pilot study utilized a pre-/postintervention design. Data were collected using a unique survey developed for this project. The intervention consisted of an online educational toolkit designed to improve the quality of care primary care physicians offer their patients with pain.Results demonstrated statistically significant improvements from pre- to postintervention for various measures including the following: (1) reported comfort in managing patients with cancer and fibromyalgia; (2) number of physicians who set functional goals for patients with pain; (3) screening for depression, substance abuse, and alcoholism; (4) documentation of efficacy of nonpharmacologic modalities; and (5) knowledge scores.The improvements seen from pre- to postintervention suggest the online toolkit had a positive impact on physician knowledge, practice patterns, and behavior toward pain management. HubMed – depression