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Medical Care Research and Review
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Primary Care Physicians' Evaluation and Treatment of Depression

Results of an Experimental Study Using Video Vignettes

Steven A. Epstein

Georgetown University School of Medicine

Lisa M. Hooper

University of Alabama, lhooper{at}bamaed.ua.edu

Kevin P. Weinfurt

Duke Clinical Research Institute

Venita DePuy

Apex, North Carolina

Lisa A. Cooper

Johns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology and Clinical Research

William G. Harless

Interactive Drama Inc.

Cynthia M. Tracy

The George Washington University Hospital

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics.

Key Words: depression • physician decision making • primary care • standardized patients

This version was published on December 1, 2008

Medical Care Research and Review, Vol. 65, No. 6, 674-695 (2008)
DOI: 10.1177/1077558708320987
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