Psychotropic Medication Discussion among Older Adults in Primary Care Office Visits

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.