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1.  Patient And phaRmacist Telephonic Encounters (PARTE) in an underserved rural population with asthma: methods and rationale 
Innovations in pharmacy  2011;2(3):49-.
Purpose
Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described.
Summary
In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings.
Conclusion
A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers.
PMCID: PMC3711922  PMID: 23864987
patient-pharmacist communication; asthma; telepharmacy
2.  Patient And phaRmacist Telephonic Encounters (PARTE) in an Underserved Rural Patient Population with Asthma: Results of a Pilot Study 
Telemedicine Journal and e-Health  2012;18(6):427-433.
Abstract
Objective: To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population. Subjects and Methods: Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants' attitudes/opinions regarding the intervention. Baseline and follow-up surveys assessed asthma control, patient activation, and medication utilization. Results: Ninety-eight adults were recruited (78% accrual); 83 completed the study (15% dropout). Participants reported positive opinions and believed the intervention improved their asthma self-management. The intervention group had significantly higher patient activation compared with the control (p<0.05). There were no significant between-group differences regarding asthma control. However, within-group analyses of the intervention group showed an improvement in asthma control (p<0.01) and medication adherence (p<0.01). No within-group differences were found for the control group. Conclusions: This telepharmacy intervention is feasible and showed indicators of effectiveness, suggesting the design is well suited for a robust study to evaluate its impact in uncontrolled asthma patients. Pharmacists helping patients manage asthma through telecommunications may resolve access barriers and improve care.
doi:10.1089/tmj.2011.0194
PMCID: PMC3399112  PMID: 22656403
patient–pharmacist communication; asthma; telepharmacy; intervention; rural; underserved
3.  Internet safety education for youth: stakeholder perspectives 
BMC Public Health  2013;13:543.
Background
Internet use is nearly ubiquitous among US youth; risks to internet use include cyberbullying, privacy violations and unwanted solicitation. Internet safety education may prevent these negative consequences; however, it is unclear at what age this education should begin and what group is responsible for teaching this topic.
Methods
Surveys were distributed to key stakeholders in youth safety education including public school teachers, clinicians, parents and adolescents. Surveys assessed age at which internet safety education should begin, as well as experiences teaching and learning internet safety. Surveys of adults assessed willingness to teach internet safety. Finally, participants were asked to identify a group whose primary responsibility it should be to teach internet safety.
Results
A total of 356 participants completed the survey (93.4% response rate), including 77 teachers, 111 clinicians, 72 parents and 96 adolescents. Stakeholders felt the optimal mean age to begin teaching internet safety was 7.2 years (SD = 2.5), range 2-15. Internet safety was regularly taught by some teachers (20.8%), few clinicians (2.6%) and many parents (40.3%). The majority of teachers, clinicians and parents were willing to teach internet safety, but all groups surveyed identified parents as having primary responsibility for teaching this topic.
Conclusions
Findings suggest agreement among key stakeholders for teaching internet safety at a young age, and for identifying parents as primary teachers of this topic. Clinicians have a unique opportunity to support parents by providing resources, guidance and support.
doi:10.1186/1471-2458-13-543
PMCID: PMC3691757  PMID: 23738647
Internet safety; Online safety; Parent education; Patient education; Survey research; Pediatrics
4.  Influence of Race and Socioeconomic Status on Engagement in Pediatric Primary Care 
Patient Education and Counseling  2011;87(3):319-326.
Objective
To understand the association of race/ethnicity with engagement in pediatric primary care and examine how any racial/ethnic disparities are influenced by socioeconomic status.
Methods
Visit videos and parent surveys were obtained for 405 children who visited for respiratory infections. Family and physician engagement in key visit tasks (relationship building, information exchange, and decision making) were coded. Two parallel regression models adjusting for covariates and clustering by physician were constructed: 1) race/ethnicity only and 2) race/ethnicity with SES (education and income).
Results
With and without adjustment for SES, physicians seeing Asian families spoke 24% fewer relationship building utterances, compared to physicians seeing White, non-Latino families (p<0.05). Latino families gathered 24% less information than White, non-Latino families (p<0.05), but accounting for SES mitigates this association. Similarly, African American families were significantly less likely to be actively engaged in decision making (OR=0.32; p<0.05), compared to White, non-Latino families, but adjusting for SES mitigated this association.
Conclusion
While engagement during pediatric visits differed by the family’s race/ethnicity, many of these differences were eliminated by accounting for socioeconomic status.
Practice implications
Effective targeting and evaluation of interventions to reduce health disparities through improving engagement must extend beyond race/ethnicity to consider socioeconomic status more broadly.
doi:10.1016/j.pec.2011.09.012
PMCID: PMC3359403  PMID: 22070902
race/ethnicity; income; education; communication; engagement; Roter Interaction Analysis System (RIAS); decision making; upper respiratory infection; pediatrics; primary care; negative binomial regression
5.  Telephonic Monitoring and Optimization of Inhaler Technique 
Telemedicine Journal and e-Health  2011;17(9):734-740.
Abstract
Introduction
Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique.
Objective
The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone.
Methods
Participants (n=30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were video-recorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre- and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0–9) and diskus (0–11) inhalers. Paired samples t-tests were used to compare telephone and video assessments.
Results
Findings indicated a significant difference between the telephone and video assessments of MDI technique (p<0.05); however, no difference was found for the diskus inhaler. Comparing pre- and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p<0.05) and from 8.5 to 10.4 (p<0.05), respectively.
Conclusions
The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.
doi:10.1089/tmj.2011.0047
PMCID: PMC3203836  PMID: 21943162
asthma; asthma management; telephonic monitoring; inhaler; metered-dose inhalers; MDI; diskus; dry powder inhalers; patient education as topic; telemedicine
6.  Medical Student Self-Efficacy with Family-Centered Care during Bedside Rounds 
Purpose
Factors that support self-efficacy must be understood in order to foster family-centered care (FCC) during rounds. Based on social cognitive theory, this study examined (1) how 3 supportive experiences (observing role models, having mastery experiences, and receiving feedback) influence self-efficacy with FCC during rounds and (2) whether the influence of these supportive experiences was mediated by self-efficacy with 3 key FCC tasks (relationship building, exchanging information, and decision making).
Method
Researchers surveyed 184 students during pediatric clerkship rotations during the 2008–2011 academic years. Surveys assessed supportive experiences and students’ self-efficacy with FCC during rounds and with key FCC tasks. Measurement models were constructed via exploratory and confirmatory factor analyses. Composite indicator structural equation (CISE) models evaluated whether supportive experiences influenced self-efficacy with FCC during rounds and whether self-efficacy with key FCC tasks mediated any such influences.
Results
Researchers obtained surveys from 172 eligible students who were 76% (130) White and 53% (91) female. Observing role models and having mastery experiences supported self-efficacy with FCC during rounds (each p<0.01), while receiving feedback did not. Self-efficacy with two specific FCC tasks, relationship building and decision making (each p < 0.05), mediated the effects of these two supportive experiences on self-efficacy with FCC during rounds.
Conclusions
Observing role models and having mastery experiences foster students’ self-efficacy with FCC during rounds, operating through self-efficacy with key FCC tasks. Results suggest the importance of helping students gain self-efficacy in key FCC tasks before the rounds experience and helping educators implement supportive experiences during rounds.
doi:10.1097/ACM.0b013e318253dcdb
PMCID: PMC3480193  PMID: 22534602
7.  Development of the patient approach and views toward healthcare communication (PAV-COM) measure among older adults 
Background
This study examines the psychometric properties of 9 items on the Patient Activation component of the Medicare Current Beneficiary Survey (MCBS) that assess how patients approach and communicate with their physicians. The MCBS is a nationally representative, cross-sectional survey of Medicare beneficiaries.
Methods
We analyzed MCBS data collected in 2002 and 2005 from 15,165 adults aged 65 and older. Exploratory factor analysis was conducted using maximum likelihood to estimate a polychoric correlation matrix on the 2002 data, and confirmatory factor analysis was performed using the 2005 data.
Results
Exploratory factor analysis of the 2002 data showed a 2-factor solution: approach to interactions (5 items) and views about physician’s healthcare communication (6 items). Findings were confirmed using the 2005 data. Items were combined to form the Patient Approach and Views toward Healthcare Communication (PAV-COM) scale (range 1 to 100; Cronbach’s alpha of 0.75, and item-rest correlations between 0.33 and 0.54). Higher PAV-COM scores were associated with greater fulfillment of preventive health behaviors such as vaccinations and cancer screenings.
Conclusions
The PAV-COM measure is a valid tool for assessing patient approaches and views toward communication with physicians. This measure can be used to evaluate interventions to improve patient participation during healthcare encounters.
doi:10.1186/1472-6963-12-289
PMCID: PMC3496598  PMID: 22931537
Physician-patient communication; Patient activation; Factor analysis
8.  Effect of Communication Style and Physician–Family Relationships on Satisfaction With Pediatric Chronic Disease Care 
Health communication  2011;27(5):498-505.
Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9–16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p < 0.05) friendliness. Satisfaction was also associated with the quality of the ongoing parent-physician (p < 0.001) and child-physician relationships (p < 0.05), comfort asking questions (p < 0.001), and trust (p < 0.01). This shows that both the communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.
doi:10.1080/10410236.2011.616632
PMCID: PMC3413374  PMID: 22077742
9.  A Pilot Evaluation of Associations Between Displayed Depression References on Facebook and Self-reported Depression Using a Clinical Scale 
The objective of this study was to determine associations between displayed depression symptoms on Facebook and self-reported depression symptoms using a clinical screen. Public Facebook profiles of undergraduates from two universities were examined for displayed depression references. Profiles were categorized as depression symptom displayers or non-displayers. Participants completed an online PHQ-9 depression scale. Analyses examined associations between PHQ-9 score and depression symptom displayers versus non-displayers. The mean PHQ-9 score for non-displayers was 4.7 (SD= 4.0), the mean PHQ-9 score for depression symptom displayers was 6.4 (SD=5.1; p=0.018). A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.
doi:10.1007/s11414-011-9258-7
PMCID: PMC3266445  PMID: 21863354
10.  Feeling Bad on Facebook: Depression disclosures by college students on a Social Networking Site 
Depression and anxiety  2011;28(6):447-455.
Background
Depression is common and frequently undiagnosed among college students. Social networking sites are popular among college students and can include displayed depression references. The purpose of this study was to evaluate college students' Facebook disclosures that met DSM criteria for a depression symptom or a major depressive episode (MDE).
Methods
We selected public Facebook profiles from sophomore and junior undergraduates and evaluated personally written text: “status updates.” We applied DSM criteria to one year of status updates from each profile to determine prevalence of displayed depression symptoms and MDE criteria. Negative binomial regression analysis was used to model the association between depression disclosures and demographics or Facebook use characteristics.
Results
A total of 200 profiles were evaluated, profile owners were 43.5% female with a mean age of 20 years. Overall, 25% of profiles displayed depressive symptoms and 2.5% met criteria for MDE. Profile owners were more likely to reference depression if they averaged at least one online response from their friends to a status update disclosing depressive symptoms (exp(B)=2.1, p<0.001), or if they used Facebook more frequently (p<0.001).
Conclusion
College students commonly display symptoms consistent with depression on Facebook. Our findings suggest that those who receive online reinforcement from their friends are more likely to discuss their depressive symptoms publicly on Facebook. Given the frequency of depression symptom displays on public profiles, SNSs could be an innovative avenue for combating stigma surrounding mental health conditions, or for identifying students at risk for depression.
doi:10.1002/da.20805
PMCID: PMC3110617  PMID: 21400639
Internet; Mental Health; Adolescent Medicine; Self Disclosure; Social Networks
11.  Problematic Internet Use Among US Youth: A Systematic Review 
Objectives
To investigate study quality and reported prevalence among the emergent area of problematic internet use (PIU) research conducted in populations of US adolescents and college students.
Data sources
We searched PubMed, PsychInfo and Web of Knowledge from inception to July 2010.
Study selection
Using a keyword search, we evaluated English-language PIU studies with populations of US adolescents and college students.
Main outcome measures
Using a quality review tool based on the STROBE statement, two reviewers independently extracted data items including study setting, subject population, instrument used and reported prevalence.
Results
Search results yielded 658 manuscripts. We identified 18 research studies that met inclusion criteria. Quality assessment of studies ranged between 14 and 29 total points out of a possible 42 points, the average score was 23 (SD 5.1). Among these 18 studies, 8 reported prevalence estimates of US college student PIU, prevalence rates ranged from 0 to 26.3%. An additional 10 studies did not report prevalence.
Conclusion
The evaluation of PIU remains incomplete and is hampered by methodological inconsistencies. The wide range of conceptual approaches may have impacted the reported prevalence rates. Despite the newness of this area of study, most studies in our review were published over 3 years ago. Opportunities exist to pursue future studies adhering to recognized quality guidelines, as well as applying consistency in theoretical approach and validated instruments.
doi:10.1001/archpediatrics.2011.58
PMCID: PMC3215336  PMID: 21536950
12.  Medical Student Outcomes after Family-Centered Bedside Rounds 
Academic pediatrics  2011;11(5):403-408.
Objective
Family-centered bedside rounds (FCBR) are recommended to improve trainee education, patient outcomes, and family satisfaction. However, bedside teaching has waned in recent years, potentially leading to less teaching and more concern for trainees. We examined medical students’ concerns, teaching evaluations, and attitudes after experiencing FCBR during the pediatric clerkship.
Methods
Data are both cross-sectional and pre- and post-clerkship surveys for 113 (89%) of 127 students. Students reported frequencies of post-clerkship concerns (14 items) and teaching experiences (17 items), with five response options (1=never, 2=rarely, 3=occasionally, 4=usually, 5=always, dichotomized with “frequent” being usually or occasionally). Students reported pre- and post-clerkship attitudes for 4 items on a 7-point scale (1=strongly disagree, 7=strongly agree). Analyses included adjusted means or proportions.
Results
The most commonly endorsed concern was presenting information in a way that was understandable to patients and families with 34.5% of students having this concern frequently. The majority of students frequently experienced 12 of the 17 teaching items. Effective teaching of physical exam skills was the teaching item least often experienced frequently by students (20.3%). Student attitudes about the benefits of FCBR for families were significantly more positive post-clerkship (mean change 0.37 pts, p<0.001), but they remained neutral in their preference for FCBR over traditional rounds without the family present (mean change −0.14 pts, p>0.05).
Conclusions
Although students demonstrate positive attitudes toward FCBR and report frequent occurrence of inpatient teaching elements, findings suggest opportunities for easing student concerns and for using this venue to teach exam skills.
doi:10.1016/j.acap.2011.01.001
PMCID: PMC3170444  PMID: 21393084
medical education; family-centered care; bedside rounds; pediatrics
13.  A Pilot Evaluation of Associations Between Displayed Depression References on Facebook and Self-reported Depression Using a Clinical Scale 
The objective of this study was to determine associations between displayed depression symptoms on Facebook and self-reported depression symptoms using a clinical screen. Public Facebook profiles of undergraduates from two universities were examined for displayed depression references. Profiles were categorized as depression symptom displayers or non-displayers. Participants completed an online PHQ-9 depression scale. Analyses examined associations between PHQ-9 score and depression symptom displayers versus non-displayers. The mean PHQ-9 score for non-displayers was 4.7 (SD = 4.0), the mean PHQ-9 score for depression symptom displayers was 6.4 (SD = 5.1; p = 0.018). A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.
doi:10.1007/s11414-011-9258-7
PMCID: PMC3266445  PMID: 21863354
14.  Pharmacists’ communication with Spanish-speaking patients: a review of the literature to establish an agenda for future research 
Background
Spanish-speaking people represent more than 12% of the total population in the United States and are poised to become the largest minority group in the U.S. by 2015. Although researchers have studied pharmacist-patient communication for approximately 30 years, little emphasis has been placed on the interactions between pharmacists and Spanish-speaking patients.
Objective
The objectives of this review are 1) to describe empirical studies on Spanish-speaking patient/pharmacist communication examined relative to patient factors, pharmacist factors, and environmental factors that may influence Spanish-speaking patient/pharmacist communication and 2) to integrate medical and nursing literature to generate a research agenda for future study in this area.
Methods
We compiled articles from a systematic review of (1) CINAHL, International Pharmacy Abstracts, Pub Med, and Web of Knowledge databases using “Hispanic limited English proficiency”, “Latino limited English proficiency”, “language-assistance services”, “Spanish-speaking patients”, “Latino patients”, “Spanish-speaking health literacy”, “pharmacy health literacy”, “patient-provider communication”, “pharmacy language barriers”, (2) bibliographies of selected articles.
Results
This search generated 1,174 articles, 7 of which met the inclusion criteria. We categorized the results into four topic areas: “Spanish-speaking patient literacy,” “pharmacists knowledge of/proficiency in the Spanish language,” “pharmacy resources to overcome language barriers,” and “pharmacists’ attitudes towards communicating with Spanish-speaking patients.”
Conclusions
These studies provide a macroscopic look at the linguistic services offered in pharmacies, gaps in services, and their subsequent impact on pharmacists and patients. Future research should investigate Spanish-speaking patients’ literacy issues, pharmacy staff language skills, factors that influence pharmacists’ counseling, and language assistance programs for pharmacists and patients. Furthermore, these studies need to be conducted in large Hispanic/Latino populated areas where positive service models are likely to be present. Addressing these issues will provide pharmacists and pharmacies with information to overcome language barriers and provide Spanish-speaking patients with quality care.
doi:10.1016/j.sapharm.2008.05.005
PMCID: PMC2875142  PMID: 19524859
Hispanic limited English proficiency; language-assistance services; Spanish-speaking patients; patient-provider communication; pharmacy language barriers
15.  Physicians’ Shared Decision-Making Behaviors in Depression Care 
Archives of internal medicine  2008;168(13):1404-1408.
Background
Although shared decision making (SDM) has been reported to facilitate quality care, few studies have explored the extent to which SDM is implemented in primary care and factors that influence its application. This study assesses the extent to which physicians enact SDM behaviors and describes factors associated with physicians’ SDM behaviors within the context of depression care.
Methods
In a secondary analysis of data from a randomized experiment, we coded 287 audio-recorded interactions between physicians and standardized patients (SPs) using the Observing Patient Involvement (OPTION) system to assess physician SDM behaviors. We performed a series of generalized linear mixed model analyses to examine physician and patient characteristics associated with SDM behavior.
Results
The mean OPTION score was 11.4 (SD=3.3) out of 48 possible points. Older physicians (partial correlation coefficient = −0.29, b = −0.09, p <.01) and physicians who practiced in an HMO setting (b = −1.60, p <.01) performed fewer SDM behaviors. Longer visit duration was associated with more SDM behaviors (partial correlation coefficient = 0.31, b = 0.08, p <.01). In addition, physicians enacted more SDM behaviors with SPs who made general (b = 2.46, p <.01) and brand-specific (b = 2.21, p <.01) medication requests compared with those who made no request.
Conclusions
In the context of new visits for depressive symptoms, primary care physicians performed few SDM behaviors. However, physician SDM behaviors are influenced by practice setting and patient-initiated requests for medication. Additional research is needed to identify interventions that encourage SDM when indicated.
doi:10.1001/archinte.168.13.1404
PMCID: PMC2533269  PMID: 18625920
Shared Decision Making; Physician-Patient Relationship; Communication; Depression; Direct-to-Consumer Advertising
16.  Abdominal Lipectomy: A Prospective Outcomes Study 
The Permanente Journal  2008;12(2):23-27.
Context/objective: Abdominal lipectomy is performed by plastic surgeons to provide symptomatic, functional, and cosmetic relief for patients with excess abdominal tissue. However, there are few clinical outcome studies looking at the utility of this procedure: this is the first prospective oucomes study.
Design: Patients who underwent abdominal lipectomy at the Bellflower Medical Center during a 12-month period (September 2004 through September 2005) were prospectively studied. Data were collected at the preoperative visit, during surgery, and at the one-week, one-month, and six-month postoperative visits.
Outcome measures: Complications, both major (requiring rehospitalization or reoperation) and minor (requiring local outpatient care) were identified. To evaluate the impact on our patients' perceived health and well-being as well as body image, we administered the Short Form–36 Health Survey (SF-36) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) to participants at their preoperative and six-month postoperative visits.
Results: For the 72 patients enrolled in the study, the postoperative major complication rate was 5.6% (four patients) and the minor complication rate was 27.8% (20 patients); 98.3% were happy to have had the surgery. Two components of the MBSRQ, feelings of attractiveness and body area satisfaction, showed significant improvement (p < 0.0001 for each) at six-month postoperative testing. No component of the SF-36 reached statistical significance between pre- and postoperative testing.
Conclusion: Because the complication rate for cosmetic abdominoplasty in our study did not significantly differ from rates reported for other studies, and given our data on perceived patient satisfaction and improvement in outcomes, our study validates the utility of abdominal lipectomy for patients with symptomatic lower abdominal pannus.
PMCID: PMC3042286  PMID: 21364808
17.  Types of Information Physicians Provide when Prescribing Antidepressants 
Journal of General Internal Medicine  2006;21(11):1172-1177.
BACKGROUND
Providing antidepressant information to patients may foster greater adherence to therapy.
OBJECTIVE
To assess physician information-giving while prescribing antidepressants, and to identify factors that influence the provision of information.
DESIGN
Randomized experiment using standardized patients (SPs). Standardized patients roles were generated by crossing 2 clinical conditions (major depression or adjustment disorder) with 3 medication request types (brand-specific, general, or none).
PARTICIPANTS
One hundred and fifty-two general internists and family physicians recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%.
MEASUREMENTS
We assessed physician information-giving by analyzing audio-recordings of interactions between physicians and SPs, and collected physician background information by survey. Generalized estimating equations were used to examine the influence of patient and physician factors on physicians' provision of information.
RESULTS
One hundred and one physicians prescribed antidepressants, accounting for 131 interactions. The mean age of physicians was 46.3 years; 69% were males. Physicians mentioned an average of 5.7 specific topics of anti-depressant–related information (of a possible maximum of 11). The most frequently mentioned topic was purpose (96.1%). Physicians infrequently provided information about the duration of therapy (34.9%) and costs (21.4%). Standardized patients who presented with major depression received less information than those with adjustment disorder, and older and solo/private practice physicians provided significantly less information to SPs.
CONCLUSIONS
Physicians provide limited information to patients while prescribing antidepressants, often omitting critical information that may promote adherence. Mechanisms are needed to ensure that patients receive pertinent antidepressant information.
doi:10.1111/j.1525-1497.2006.00589.x
PMCID: PMC1831652  PMID: 17026727
physician; communication; drug information
18.  Sphincter Dilatation for Anal Fissure 
British Medical Journal  1963;1(5323):126.
PMCID: PMC2122555  PMID: 14002793
20.  Appendix in Hernial Sac 
British Medical Journal  1953;2(4847):1216.
PMCID: PMC2030167

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