Discussion of depression in follow-up medical visits with older patients.
Discussion of depression in follow-up medical visits with older patients.
复制标题
老年患者随访中抑郁症的讨论。
DOI：
10.1111/j.1532-5415.2007.01504.x
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发表时间：
2008
影响因子：
6.3
通讯作者：
Cook,MaryAnn
中科院分区：
文献类型：
--
作者：
Adelman,RonaldD;Greene,MicheleG;Friedmann,Erika;Cook,MaryAnn
目的：确定老年患者随访医疗访视中有关抑郁症的讨论频率，由谁发起这些讨论，医生和患者在这些讨论中的反应质量，以及影响这些讨论的患者和医生特征。设计：482例听力随访访视的便利样本。地点：3个社区为基础的实践站点。参与者：376例无痴呆症的社区老年患者和43名初级保健医生。测量：使用多维交互分析系统分析录音带，以确定医疗对话的内容和过程。患者在就诊后立即完成了医疗结局研究36项简短调查问卷。结果：7.3%的医疗就诊中讨论了抑郁症;医生在41%的就诊中提出了这个话题，患者在48%的就诊中提出了这个话题，陪同人员在10%的就诊中提出了这个话题。当讨论抑郁症的话题时，访问时间更长。抑郁症几乎完全是在医患关系的前2.5年中出现的。有一些老年训练的医生更有可能讨论抑郁症，这些访问时间短于访问医生没有老年训练。结论：抑郁症在随访中很少出现。老年人抑郁症的高患病率和相关的死亡率值得在早期和后期的医患关系中讨论抑郁症。虽然当讨论抑郁症时，访问时间更长，但与没有接受过老年医学培训的医生相比，接受过一些老年医学培训的医生更有可能提出抑郁症，并且在这样做时更有时间效率。
OBJECTIVES:To determine the frequency of discussion about depression in follow‐up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions.DESIGN:Convenience sample of 482 audiotaped follow‐up visits.SETTING:Three community‐based practice sites.PARTICIPANTS:Three hundred seventy‐six community‐dwelling older patients without dementia and 43 primary care physicians.MEASUREMENTS:Audiotapes were analyzed using the Multi‐Dimensional Interaction Analysis system to determine the content and process of medical conversations; patients completed Medical Outcomes Study 36‐item Short Form Survey questionnaires immediately after the visit.RESULTS:Depression was discussed in 7.3% of medical visits; physicians raised this topic in 41% of visits, patients raised it in 48% of visits, and accompanying persons raised it in 10% of visits. Visits were longer when the topic of depression was discussed. Depression was raised almost exclusively in the first 2.5 years of the patient–physician relationship. Physicians with some geriatric training were more likely to discuss depression, and these visits were shorter than visits to physicians without geriatric training.CONCLUSION:Depression was raised infrequently in follow‐up visits. The high prevalence of depression in older people and the associated mortality merit discussion of depression early and later in the patient–physician relationship. Although visits were longer when depression was discussed, physicians with some geriatric training were more likely to raise depression, and more time‐efficient when they did so, than physicians without geriatric training.
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