Study outlines rural PCP preferences when treating older adults with depression

Rural primary care physicians reported comfortability with remote consultation for older patients with depression but wanted more collegial communication with these consultants, according to study findings.

“[Although] there are a variety of remote telehealth models available to assist rural PCPs in the care of older patients with [depression, pain and suicidal ideation], … blending pharmacy identification, remote assessment by a mental health clinician and focused consultation recommendations provided to both patient and PCP is a unique care approach for rural areas to identify patients at risk and improve outcomes,” Jordan F. Karp, MD, of the department of psychiatry at University of Pittsburgh School of Medicine, and colleagues wrote in The Primary Care Companion for CNS Disorders.

The investigators aimed to update the Pharmacy Identification and Primary Care Intervention of Older Adults at Risk for Suicide (PREDICTOR), a rural pharmacy screening and intervention approach. They performed qualitative interviews with rural PCPs that asked about caring for seniors with depression, pain and suicidality, as well as the PCPs’ preferred methods for collaborating with psychiatric consultants and which professional characteristics made for an effective consultant. The investigators used a best-practice approach that included double coding for qualitative interviews with 10 PCPs who practiced in rural Pennsylvania.

Results showed four major themes among the rural PCPs:

• they became comfortable managing older adults’ depression out of necessity, but they wanted collaboration when managing more complex mental health care;

• they described older adults’ comorbid depression and pain as being related through a “vicious cycle”;

• they had varying comfort levels regarding prescribing opioids for pain management among older patients, with most preferring not to prescribe them and some refusing to; and

• they endorsed PREDICTOR as possibly benefiting themselves and their older patients while still desiring collaboration in a collegial and professional relationship with a consultant.

“Given the lack of a common electronic medical record (of note, none of the PCP participants shared an electronic medical record system with us), screening at community pharmacies based on prescription status and then providing decision support to the prescribing PCPs may be more efficient than trying to screen from a variety of disconnected PCP practices,” Karp and colleagues wrote. “As we move forward with testing PREDICTOR on a larger scale, the lack of a shared electronic medical record across primary care practices will require implementation of creative communication solutions to assure PCPs receive remote mental health consultations in a consistently useful manner.”