Treatment decisions on antidepressants in nursing homes: A qualitative study

Abstract

Objective. To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. Design and subjects. A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. Results. The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses’ observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. Conclusions. This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.

Key Words::

• Antidepressants
• nurses
• nursing homes
• physicians
• qualitative study
• treatment decisions

Acknowledgement

The authors would like to thank thank all informants who participated in the focus-group interviews.

Ethics

The Western Regional Committee for Medical and Health Research Ethics and the Norwegian Data Inspectorate approved the study.

Source of funding

Norwegian Medical Association.

Conflict of interest

All authors declare that there are no competing interests.