223398 Psychotropic Medication Discussion among Older Adults in Primary Care Office Visits

Monday, November 8, 2010

SangNam Ahn, PhD, MPSA , Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN
Ming Tai-Seale, PhD, MPH , Health Policy and Management, Texas A&M Health Science Center, College Station, TX
Chuck Huber, PhD , Epidemiology & Biostatistics, Texas A&M HSC School of Rural Public Health, College Station, TX
Matthew Lee Smith, PhD, MPH, CHES , School of Rural Public Health, Texas A&M Health Science Center, College Station, TX
Marcia G. Ory, PhD, MPH , Social & Behavioral Health, Texas A&M HSC School of Rural Public Health, College Station, TX
Background. Psychotropic medication is widely prescribed to manage mental disorders among seniors. This study contributes to the scarce literature examining discussion about psychotropic medication, especially in the presence of competing demands that may deter patient-physician communication.

Methods. Based on a secondary analysis of 392 videotaped physician visit transcripts, the current study focuses on 59 encounters containing mental health content. Factors examined included: types of psychotropic medication information provided by the physician; types of mental health complaints; and competing demands for physicians' time and attention. Logistic regression was performed to explore the contributions of competing demands and characteristics of patients and physicians to the likelihood of having a psychotropic medication discussion (i.e., the proportion of discussion of psychotropic prescription medication over discussion of any prescription medication).

Results. Only 27% of prescription medication discussions focused on psychotropic medication. Physicians discussed drug purposes (57.6%) and brand names (57.6%) relatively more often than side effects (32.2%) and usage recommendations (16.9%). Physicians and patients tended to discuss psychotropic medication more if the patient had depression or suicidal thoughts (OR=1.23). A lower proportion of psychotropic medication discussion during visits was associated with having an increased number (≥3) of activity limitation causes (OR=0.56) and an increased number (7-8 and ≥9) of topics discussed (OR=0.59 and OR=0.17, respectively).

Conclusion. Suboptimal medication counseling about side effects and usage of prescribed psychotropic medication is widespread in older patients-doctor encounters. Educational and policy strategies are needed to counter the effects of competing demands of physicians' resources.

Learning Areas:
Public health or related education
Public health or related public policy
Public health or related research

Learning Objectives:
1. List information that physicians give patients about psychotropic medication. 2. Explore the independent contribution of competing demands and characteristics of patients and physicians to the likelihood of having a psychotropic medication discussion. 3. Identify policy implications of communication between primary care physicians and older patients regarding psychotropic medication.

Keywords: Mental Health Care, Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have built the conceptual models, analyzed data, and composed the abstract and manuscript.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.