Primary care physicians’ medical decision making for late-life depression

1996 ◽  
Vol 11 (4) ◽  
pp. 218-225 ◽  
Author(s):  
Christopher M. Callahan ◽  
Robert S. Dittus ◽  
William M. Tierney
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Late Life ◽  
Medical Decision ◽  
Late Life Depression

scholarly journals Medical decision making among patients with heart failure – does migration background matter?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olaf von dem Knesebeck ◽  
Martin Scherer ◽  
Gabriella Marx ◽  
Sarah Koens
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Migration Background ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnosis And Management ◽  
Migration History

Abstract Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%. Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.

scholarly journals Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Qualitative Research ◽  
Primary Care Physicians ◽  
Medical Decision ◽  
Published Data ◽  
Qualitative Evidence Synthesis ◽  
Thematic Synthesis ◽  
Qualitative Evidence

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.

scholarly journals Regulatory focus affects physician risk tolerance

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Peter J. Veazie ◽  
Scott McIntosh ◽  
Benjamin P. Chapman ◽  
James G. Dolan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Regulatory Focus ◽  
Primary Care Physicians ◽  
Randomization Test ◽  
Practice Variation ◽  
Risk Tolerance ◽  
Medical Decision ◽  
Test Results ◽  
Physician Decision Making

Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention – regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (P=0.01). The Cohen’s d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (P=0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

The Prevalence of Late-Lifedepression and Physicians’ Attitude Toward it in Primary Care Settings of China

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Chen
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Older People ◽  
Primary Care Physicians ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Late Life ◽  
Well Being ◽  
Late Life Depression ◽  
Primary Care Settings

Late-life depression is associated with physical and psychological comorbidity, functional and cognitive impairment, and increased mortality due to suicide and other causes. However, studies in the west show that the identification of depression in older people is problematic and consequently the illness is underdiagnosed and undertreated. We investigated the prevalence of late-life depression and physicians’ attitude toward it in primary care settings of China.The survey was performed in urban primary care settings of Hangzhou, China. 1000 patients aged ≥ 55 years and 300 primary care physicians were recruited, of which 689 patients and 247 physicians provided complete data. The Geriatric Depression Scale (GDS-30) was used for investigating the prevalence of late-life depression in patients, and the Depression Attitude Questionnaire (DAQ) for investigating physicians’ attitudes and knowledge about depression.Of the 689 patients, 23.4% (n=161) scored ≥ 11 on the GDS-30, including 3% (n=21) who scored ≥ 21. Among the physicians, 72% (n=178) endorsed that “Becoming depressed is a natural part of being old”, and 70% (n=173) of them thought “Working with depressed patients is heavy going”; in their clinical practice. Only 6.6% of physicians prescribed anti-depressants.Primary care physicians in China are ill prepared to diagnose and treat depression in older adults, which presents at high rates in primary care clinics. How to improve their attitudes and clinical practice is crucial to the well-being of older people in China.

scholarly journals Medical Decision Making and Primary Care

1982 ◽  
Vol 2 (4) ◽  
pp. 401-402 ◽  
Author(s):  
Anthony L. Komaroff ◽  
Theodore M. Pass
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision

Primary Care Physicians' Attitude Toward Diagnosis and Treatment of Late-life Depression

CNS Spectrums ◽  
2002 ◽  
Vol 7 (11) ◽  
pp. 784-790 ◽  
Author(s):  
Jeffrey S. Harman ◽  
Ellen L. Brown ◽  
Thomas Ten Have ◽  
Benoit H. Mulsant ◽  
Greg Brown ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Primary Care Physicians ◽  
Late Life ◽  
The Elderly ◽  
Late Life Depression ◽  
Primary Care Settings ◽  
Care Groups ◽  
Physician Characteristics ◽  
Barrier To Care

ABSTRACTUnderdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians' attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians' confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.

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