In This Issue

Five research articles and an editorial in this issue address the diagnosis and treatment of depression in primary care. Together, this research takes us through the diagnostic process in primary care¹ to factors associated with depressed patients’ intent to accept the diagnosis,² to factors affecting adherence to treatment.³ Depression research in this issue identifies the need to tailor interventions to subgroups of patients with primarily psychological or physical symptoms,⁴ and shows the cost-effectiveness of enhanced primary care management of depression.⁵ The editorialist presents a framework for interpreting these studies.⁶ Moreover, he draws a larger cautionary lesson about forces that are disintegrating primary care practice through efforts to control the cost and quality of mental health and chronic disease, to the possible detriment of the patients with those conditions.

In research that contradicts common perceptions, Vinson and colleagues⁷ discover that injuries requiring emergency department visits are associated more with an occasion of drinking than with alcohol dependence.

Concerns that physician values may be shifting are supported empirically by Beach and colleagues,⁸ in a study of physicians in 11 managed care organizations. These researchers find that a strong sense of physician responsibility to individual patients is less common among younger physicians and physicians who practice in staff-model health maintenance organizations. Interestingly, a sense of responsibility to individual patients is associated with physician satisfaction with practice.

Evidence of the epidemic of diabetes is provided by Koopman and colleagues, using nationally representative data.⁹ They find that between the 1988–1994 and 1999–2000 National Health and Nutrition Examination Survey studies, the age of diagnosis of type 2 diabetes has decreased from 52 to 46 years. These data most likely show the combined effect of earlier onset of disease, changing diagnostic criteria, and increasing recognition of diabetes, and they portend growing challenges for the health care system.

Meadows and colleagues use qualitative methods to develop a typology of women’s perceptions of future risk for fractures after having suffered a low-impact fracture.¹⁰ The authors identify 3 belief systems among women in this study, which seem to call for different clinical approaches to individualizing care.

The study of a community advisory board provides powerful lessons for engaging the community voice in participatory research.¹¹ This brief article summarizes important lessons, and the more detailed online appendix¹² brings these lessons to life by showing the lives from which these lessons emerge.

A methodological study by Glasgow and colleagues represents an important springboard for research to advance the science of health behavior change.¹³ These authors identify approaches to measuring health behavior change that are practical to implement in primary care and practice-based research. The online appendixes¹⁴ show the actual instruments for those who wish to use them.

Finally, a distinguished ethicist and practicing family physician shows that from the perspectives of professional integrity and time management, physicians should refuse to see pharmaceutical sales representatives.¹⁵ This careful analysis shows that arguments for developing relationships with reps are hollow rationalizations and that these relationships are at odds with our patients’ interests. If we are listening, this is a call to action.

We look forward to a thoughtful and lively online discussion of these studies at http://www.annfammed.org.

• © 2005 Annals of Family Medicine, Inc.