Joint consultations with patient, GP and geriatric psychiatrist for older adults with depression: - a focus group study

Background: Depression in older adults is common in general practice, but the optimal approach for identification and treatment is not entirely clear. Aim: To explore physicians’ experiences with a structured collaboration model based on joint consultations between patients, general practitioners (GPs) and geriatric psychiatrists for treating depression in patients aged 65 and older. Methods: A focus group study was conducted with three groups, totalling 13 physicians (10 GPs and 3 psychiatrists) who had participated in the collaborative model and recently had participated in a cluster randomised intervention study. The analysis was performed using the Systematic Text Condensation method. Results: Five main themes emerged from the analysis: 1) Challenges in diagnostics, 2) Advantages of the model, 3) Feasibility, 4) Overdiagnosis and overtreatment, and 5) Adjustments to the model. The GPs identified a challenge in patients’ strong focus on somatic symptoms, often reinforced by GPs due to time constraints and overshadowing depressive symptoms. Both GPs and psychiatrists recognized the structured collaborative model, which strengthened the GP-patient relationship and enabled mutual learning. The GPs’ presence during joint consultations was crucial for patient participation. The model filled a gap where GPs lacked effective interventions and was praised by psychiatrists as highly cost-effective. All participants supported broader implementation of joint consultations in clinical practice. Conclusion: The GPs' enthusiasm for this collaborative approach indicates an unmet need in the treatment of older patients with depression. By strengthening both the doctor-patient relationship and interdisciplinary collaboration between GPs and psychiatrists in a cost-effective manner, the use of such joint consultations should be further investigated.