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APHA Scientific Session and Event Listing

Ming Tai-Seale, PhD, MPH, Health Policy and Management, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843, 979 845 2387, mtaiseale@srph.tamhsc.edu

Late-life mental disorders are common. The prevalence of major depression is 6-9% and milder depressive symptoms affect up to an additional 37% elderly population. Despite interests in measuring mental health care quality, very few studies have directly observed how mental health care is delivered. This study assessed the actual care process using videotapes of office visits.

Qualitative and quantitative methods studied 392 primary care visit videotapes from 3 locations between 1998 and 2000. The videotapes were coded to obtain data on the nature of the topics discussed and the time spent on each topic. Patient and physician surveys provided additional information.

Mental health topics occurred in 20.2% of visits, accounting for 3.5% of total topics. The average time a physician spent discussing mental health issues was less than one minute (58.8 seconds) in comparison to 65.9 seconds on biomedical topics (p>0.05). A patient spent, on average, 114.8 seconds on mental health topics, compared with 57.2 seconds on biomedical topics (p<0.01). Female and family practitioners were twice more likely to discuss mental health than male and other physicians (p<0.01). In-depth discussions of psychotropic medications were uncommon, so were recommendations for psychotherapy or referrals to mental health specialists.

Only 3 minutes were spent on mental health issues during elderly patients' office visits. The contents of interactions on mental health often appeared superficial. Having a visit, by itself, does not guarantee that patients will receive guideline-concordant mental health services. Quality improvement effort should take into account how mental health care is actually delivered.

Learning Objectives:

• introducing an innovative approach to measure quality of care for patients with depression in primary care settings
• examine the process of care deliverred to patients with depression in primary care settings
• discuss research findings and implications to clinical practice, research and policy

Keywords: Depression, Quality of Care

Presenting author's disclosure statement:

Not Answered