Reported differences in management strategies by primary care physicians and psychiatrists in older patients who are depressed

Abstract

Objective: To compare reported management suggestions by primary care physicians and psychiatry specialists for case vignette examples of old age depression, and to explore further training needs in geriatric depression for both professional groups.

Design: Qualitative study using case vignettes in focus groups. Single group training sessions were arranged for 25 primary care physicians and 11 psychiatrists. The same two clinical vignettes were presented at all training sessions. Written management suggestions by participants, group discussion field notes and transcripts of group session videotapes were analysed.

Results: Differences emerged in intended depression management. Primary care physicians tended to assess the symptoms as less serious and the situation as less urgent than psychiatrists. Management suggestions given by the psychiatrists included more recommendations of immediate psychiatric treatment and more precise descriptions of medication. Both groups recognized the somatic issues and were willing to assume responsibility for treatment.

Conclusions: Identifying management differences seems to benefit the professional development of both groups. Exploring and discussing the underlying reasoning leading to management differences may be a productive format for primary care doctors and psychiatric specialists to teach and learn together. It may also promote collaboration in caring for the depressed elderly.