Treatment of Depression in Homecare Patients

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This proposed study of A Physician's Decision: Treatment of Depression Homecare Patients requests 1 year of funding to conduct a pilot investigation into the primary care physicians' perspectives on anti- depressant treatment for t6heir older patient receiving homecare nursing for medical or surgical problems. Depression is highly prevalent in home care patients but usually unrecognized and rarely treated. This pilot will augment the Cornell-Visiting Nurse Services of New York (VNSNY) Depression Treatment Study of the effectiveness of nurse initiated and managed antidepressant treatment for geriatric depression. The primary aims of this study are to (1) describe the knowledge and attitudes of physicians toward antidepressant treatment for older homecare patients, (2) identify both physician-specific and patient-specific factors associated with the physician's willingness to initiate antidepressant treatment in the older depressed home health patient, and (3) describe the interaction between the Advanced Practice Psychiatric Nurse and the treating physician in initiating and managing depression in older adults. The proposed study will contact and attempt to interview the 80 primary care physicians whose patients were enrolled in the Cornell-VNSNY Depression Treatment Study. These data as well as information collected by the study's Advanced Practice Psychiatric Nurse about her interaction with each primary care physician, the patient medical record and the patient interview will be used to address the study aims. Funds are being requested to collect additional data to build on and extend ongoing research with the overall goal of improving recognition and treatment of late-life depression in older health care patients.