Diagnose und Therapie einer Depression im höheren Lebensalter – Einflüsse von Patienten- und Arztmerkmalen

摘要

Studies from the United States and the United Kingdom show variations in medical decision making concerning the primary care of depression. Patient and physicians attributes independently influence doctors’ decisions regardless of the patients’ condition. In this paper results are presented on how these factors influence primary care doctors' diagnostic and management decisions regarding a depression in Germany.A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of a depression. A videotape with typical symptoms of the disease under study was produced where actors differ according to age (55 vs. 75 years), gender, and social status (teacher vs. janitor) in order to mirror respective patient characteristics. The videotape was presented to a total of 128 randomly selected primary care physicians in Germany, taking gender and duration of professional experience (< 5 vs. > 15 years) into account. Physicians confronted with the videotape were asked to judge the clinical condition and to give recommendations for diagnosis and therapy. In particular, the physicians were asked what questions they would ask, to name the most likely diagnoses, what their certainty levels were, which test(s) they would order, which medication(s) they would prescribe, and what lifestyle recommendation(s) they would make if they saw the patient from the video in their everyday clinical practice.Contrary to international studies results show only minor variation in the primary care of depression. Thus, in most aspects care of depression in Germany seems to be independent from patients’ and physicians’ characteristics under study.