Objective: The objective of this studywas to examineprimarycare physicians' propensityto assess theirelderlypatientsfor depression using data from videotapes and patient and physician surveys. Study Design: An observationalstudy was informedby surveys of 389 patientsand 33 physicians, and 389 videotapesof theirclinical interactions.Secondaryquantitativeanalysesused video datascored by the Assessment of Doctor-Elderly Patient Transactionssystem regardingdepressionassessment.A random-effectslogit model was used to analyze the effects of patient health, competing demands, and racial and gender concordance on physicians' propensity to assess elderly patients for depression.

Results: Physicians assessed depressionin only 14%of the visits. The use of formal depression assessment tools occurred only 3 times. Whitepatientswere almost7 times morelikely thannonwhite patients to be assessed for depression (odds ratio [OR], 6.9; P < 0.01). Depression assessment was less likely if the patient functioned betteremotionally (OR, 0.95; P < 0.01). The propensityof depression assessment was higher in visits that covered multiple topics (OR, 1.3; P < 0.01) contraryto the notion of competing demands crowding out mental health services. Unexpectedly, depression assessment was less likely to occur in gender and racially concordantpatient-physiciandyads.

Conclusions: Primarycarephysiciansassessedtheirelderlypatients for depressioninfrequently.Reducingthe numberof topics covered in visits and matching patients and physicians based on race and gendermay be counterproductiveto depressiondetection.Informed by videotapes and surveys, our findings offer new insights on the actual care process and present conclusions that are differentfrom studies based on administrativeor survey dataalone.