Methods for Assessing Patient–Clinician Communication about Depression in Primary Care: What You See Depends on How You Look

Authors

  • Stephen G. Henry M.D.,

    Corresponding author
    1. Division of General Medicine, Geriatrics, and Bioethics, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
    • Address correspondence to Stephen G. Henry, M.D., Division of General Medicine, Geriatrics, and Bioethics, 4150 V Street, Suite 2400, Sacramento, CA 95817; e-mail: sghenry@ucdavis.edu.

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  • Bo Feng Ph.D.,

    1. Department of Communication, University of California Davis, Davis, CA
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  • Peter Franks M.D.,

    1. Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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  • Robert A. Bell Ph.D.,

    1. Departments of Communication and Public Health Sciences, Center for Healthcare Policy and Research, University of California Davis, Davis, CA
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  • Daniel J. Tancredi Ph.D.,

    1. Department of Pediatrics, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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  • Dustin Gottfeld B.S.,

    1. Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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  • Richard L. Kravitz M.D., M.S.P.H.

    1. Division of General Medicine, Geriatrics, and Bioethics, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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Abstract

Objective

To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts.

Data

One hundred sixty-four primary care visits from seven health care systems (2010–2011).

Study Design

Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician postvisit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated.

Principal Findings

Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44–75 percent). Clinician report was sensitive for all symptoms (83–98 percent) and specific for sleep, memory, and suicide (80–87 percent), but not for other symptoms (45–48 percent). Chart review was not sensitive for symptoms (50–73 percent), but it was specific for sleep, memory, and suicide (88–96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24–42 percent, clinician report 38–50 percent, chart review 49–67 percent) but high specificity (89–96 percent). For definite follow-up plans, all three indirect measures were sensitive (82–96 percent) but not specific (40–57 percent).

Conclusions

Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively.

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