The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we encourage diverse participants—particularly among students, trainees, residents, and interns—to think critically about and discuss important issues affecting primary care, and even consider how their discussions might inform their practice.
HOW IT WORKS
The Annals provides discussion tips and questions related to one original research article in each issue. We welcome you to post a summary of your conversation to our eLetters section, a forum for readers to share their responses to Annals articles. Further information and links to previous Annals Journal Club features can be found on our website.
DISCUSSION TIPS
Depression can be a challenging condition for primary care clinicians to treat, given remission from medications is often suboptimal. We often offer/recommend counseling for patients who are interested in counseling, but generally don’t recommend specific types of counseling out of primary care. This trial studies an interesting question of whether collaborative, trauma-informed care leads to better outcomes at 6 months than usual care.
Discussion Questions
What question is asked by this study and why does it matter?
∘ What is the justification for this specific intervention in this population?
∘ How does this study advance beyond previous research and clinical practice on this topic?
∘ How strong is the study design for answering the question?
∘ What is a cluster randomized controlled trial and how is this different from a normal randomized controlled trial?
∘ What is CONSORT?
∘ What is important to consider in the statistical analysis of cluster randomized controlled trials (ie, hierarchical data)?
What is an intra-cluster correlation and why does it matter?2
To what degree can the findings be accounted for by:
∘ How practices were recruited and randomized?
∘ How patients were selected to participate?
∘ The comparator intervention?
∘ The statistical modeling?
∘ Missing data and imputation?
What are the main study findings?
How comparable is the study sample to similar patients in your practice or region? What is your judgment about the transportability of the findings?
What contextual factors are important for interpreting the findings?
How might this study change your practice? Policy? Education? Research?
Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?
What are the next steps in interpreting or applying the findings?
What researchable questions remain?
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