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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3014 — A Comparison of Perceptions of Primary Care Provider Behavior among Veterans by Age

Bolkan CR (COE - Seattle), Chaney EF (COE - Seattle), Uman J (COE - Seattle), Rubenstein LV (COE - Sepulveda), Yano EM (COE - Sepulveda)

Objectives:
Although prior research indicates that elderly primary care patients benefit as much, or more, from depression treatment as younger patients, they are actually much less likely than younger patients to start or complete guideline-concordant depression treatment. This includes depression detection, assessment, treatment initiation, and treatment adjustment. These lower rates may reflect either patient or clinician reluctance to recognize and treat late life depression. We explored whether elderly patients perceived that their clinicians offered them guideline-concordant depression care.

Methods:
We collected data on patient perceptions using telephone interviews as part of an evidence based care model study (TIDES/WAVES) to investigate the effectiveness of collaborative care for the treatment of depression. The analyses reported here are based on a sample of 760 representative depressed patients (Patient Health Questionnaire, PHQ-9 > 10) visiting one of 10 VA primary care clinics in one of 3 VA networks across diverse regional areas. We performed chi-square tests of independence to examine the relationships between variables.

Results:
Patients aged 60 + (M = 72.1; 43.1% of sample) were compared to patients < age 59 (M = 52.5; 56.9% of sample).The two groups did not differ on perceived health status or depressive symptom severity. Older patients, compared to younger patients, reported that their providers were less likely to inquire about being sad or depressed, ?2 (1, N = 628) = 3.90., p = .05), about alcohol use, ?2 (1, N = 634) = 3.79., p = .05), or about self-harm thoughts, ?2 (1, N = 640) = 17.19., p = .00). Older patients also reported that their providers were less likely to prescribe medication for an emotional problem, ?2 (1, N = 642) = 8.69., p = .00), or change an existing prescription, ?2 (1, N = 643) = 11.78., p = .00).

Implications:
Older patients, compared to younger patients, perceived that their primary care providers were less likely to offer them guideline-concordant depression care.

Impacts:
Addressing recovery from late life depression will involve substantial changes in clinician responsiveness to the depression symptoms and care needs of elderly patients. It may be necessary to incorporate a specific geriatric focus in depression care interventions for veterans.


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