Earlier versions of this paper were presented at the 2006 Annual Research Meeting of AcademyHealth, the 2006 Annual Meeting of the Society of General Internal Medicine, and the Thirteenth Biennial Mental Health Economics meeting at the National Institute of Mental Health.
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
Journal of the American Geriatrics Society
Volume 55, Issue 12, pages 1903–1911, December 2007
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
- Issue published online: 7 DEC 2007
- Article first published online: 7 DEC 2007
- 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.