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Screening for Depression in Patients in Long‐Term Care Facilities: A Randomized Controlled Trial of Physician Response
Author(s) -
Soon Judith A.,
Levine Marc
Publication year - 2002
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1046/j.1532-5415.2002.50266.x
Subject(s) - medicine , referral , randomized controlled trial , depression (economics) , confidence interval , mental health , primary care physician , intervention (counseling) , logistic regression , geriatric depression scale , family medicine , emergency medicine , psychiatry , primary care , cognition , depressive symptoms , economics , macroeconomics
OBJECTIVES: To determine the effect of a screening protocol using the Geriatric Depression Scale (GDS) on the frequency of primary care physicians' decisions to prescribe drug therapy or refer long‐term care patients with possible depression to mental health care. DESIGN: Case‐finding phase, followed by a randomized controlled trial of the effect of a physician‐targeted intervention on antidepressant prescribing or referral to mental health services. SETTING: Twenty‐two nonacademic long‐term care facilities. PARTICIPANTS: One hundred three of 1,602 patients aged 65 and older who met criteria for cognitive function and untreated symptoms of depression. INTERVENTION: The 77 physicians of these patients were randomized as clusters into an early notification (experimental) or a delayed notification (control) group. MEASUREMENTS: Frequency of physician response (mental health consult or antidepressant therapy) at 4 and 8 weeks from notification, physician follow‐up, and factors associated with physician response. RESULTS: Frequency of physician response in the early group (25%) was greater than in the delayed group (2%) ( P < .005) 4 weeks from baseline. Physician response rate when the groups were combined was 36% (95% confidence interval (CI) = 26%–46%) 8 weeks from notification. Overall, there was evidence of physician action after letters of notification in 69% (95% CI = 60%–78%) of cases. Univariate logistic regression suggested that physicians' decisions were primarily associated with physician‐related characteristics. CONCLUSIONS: Screening of long‐term care patients for depression can increase the frequency of treatment or referral by primary care physicians.