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Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits
(See editorial comments by Drs. Charles Reynolds, Mario Cruz, Carrie Farmer Teh, and Bruce L. Rollman)
Article first published online: 7 DEC 2007
DOI: 10.1111/j.1532-5415.2007.01467.x
Additional Information
How to Cite
Tai-Seale, M., McGuire, T., Colenda, C., Rosen, D. and Cook, M. A. (2007), Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits. Journal of the American Geriatrics Society, 55: 1903–1911. doi: 10.1111/j.1532-5415.2007.01467.x
Publication History
- Issue published online: 7 DEC 2007
- Article first published online: 7 DEC 2007
- Abstract
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Keywords:
- mental health;
- primary care;
- geriatric patients;
- time use;
- quality of care
OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients.
DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health.
SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners.
PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients.
MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk.
RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients.
CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits “during which a mental health problem is discussed” may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed.