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HSR&D 2004 National Meeting Abstracts

1001. Race and Primary Care Physician Diagnosis/Treatment of Geriatric Depression
Helen C Kales, MD, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), VA HSR&D, Ann Arbor VAMC, HW Neighbors, University of Michigan School of Public Health, M Valenstein, SMITREC, VA HSR&D, Ann Arbor VAMC, FC Blow, SMITREC, VA HSR&D, Ann Arbor VAMC, KK Taylor, SMITREC, VA HSR&D, Ann Arbor VAMC, L Gillon, SMITREC, VA HSR&D, Ann Arbor VAMC, RV Ignacio, SMITREC, VA HSR&D, Ann Arbor VAMC, SM Maixner, University of Michigan Department of Psychiatry, AM Mellow, Mental Health Service Line, Veteran Healthcare Network 11

Objectives: Many older veterans with depression are treated not in mental health settings but in primary care. Our study examined primary care physician (PCP) contributions toward racial differences in the diagnosis and treatment of geriatric depression.

Methods: Volunteer PCPs were randomly assigned to one of four standardized video vignettes of an elderly patient depicting geriatric depression. Vignettes differed only in the actor-“patient’s” race (white/African American) or gender. Participants were US-practicing post-residency PCPs (n=178) at the 2002 American Academy of Family Physicians Meeting.

Results: PCPs’ diagnosis, first-line treatment and management recommendations, and judgment of personal characteristics for the patients in the vignettes were assessed. Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. By patient race or gender, there were no significant differences in the diagnosis of depression, treatment recommendations or PCP assessment of most patient characteristics. However, PCP characteristics, most notably location of medical school training (U.S. vs. International) did effect depression diagnosis and treatment recommendations. International graduates were significantly less likely to diagnose depression, use newer antidepressants, or follow patients long term than US graduates.

Conclusions: Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as white elderly.

Impact: Our results suggest that racial bias is not a likely explanation for lower rates of depression diagnosis and treatment among African American elders and are reassuring for older minority veterans treated in primary care settings. PCPs who trained at international medical schools may benefit from targeted initiatives on geriatric depression.