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Exploring and validating patient concerns: relation to prescribing for depression.

Ronald M Epstein¹, Cleveland G Shields, Peter Franks

¹Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14610, USA. Ronald_Epstein@urmc.rochester.edu

Annals of Family Medicine

|January 31, 2007

Summary

Physician communication significantly impacts antidepressant prescribing. High-quality communication ensures prescribing aligns with clinical needs, not just patient requests, improving depression care.

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Area of Science:

Medical Communication
Psychiatry
Health Services Research

Background:

Patient requests for antidepressants can influence prescribing decisions.
Physician communication behaviors may moderate the relationship between patient requests and prescribing.
Understanding these dynamics is crucial for optimizing depression treatment.

Purpose of the Study:

To examine how physician communication behaviors moderate the link between patient requests for antidepressants and actual prescribing.
To investigate the role of exploring and validating patient concerns (EVC) in antidepressant prescribing.

Main Methods:

Secondary analysis of a randomized trial involving 152 primary care physicians and standardized patients.
Covert audio recordings were coded for physician exploration and validation of patient concerns (EVC).
Logistic regression analyzed the effects of communication on prescribing, stratified by request type and diagnosis.

Main Results:

In low EVC visits, prescribing was highly influenced by patient requests, not clinical indications.
In high EVC visits, prescribing was equally driven by patient requests and clinical indications for depression.
Thorough symptom history taking did not mediate these communication effects.

Conclusions:

Enhanced physician communication (high EVC) improves the quality of depression care by balancing patient requests with clinical needs.
Interventions should target both physician and patient communication to improve care quality.
Further research is needed on cognitive mechanisms linking patient requests, EVC, and care quality.