Table of Contents

The Issue in Brief

The Issue in Brief

Cost Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis
By Kathryn Rost, PhD, and colleagues
This study provides the first evidence that when depressed patients are cared for in the primary care doctor�s office for an extended period, they have better results, and the treatment becomes less costly. In this study, depressed patients were encouraged to take part in active treatment and received regularly scheduled care for 2 years. These patients had more depression-free days than patients who received regular care. The care was found to be cost-effective and, according to the authors, is an efficient use of health care resources. The authors encourage health plans to provide for long- rather than short-term depression management.

RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-year Costs for Patients with Physical vs Psychological Complaints
By L. Miriam Dickson, PhD, and colleagues
Providing long-term (2-year) treatment in the primary care doctor�s office for depressed patients results in less depression as well as cost savings for patients who report psychological symptoms (such as depressed mood, anxiety, or low self-esteem). Such treatment has limited benefits and increases costs, however, for patients who report mostly physical symptoms. The findings suggest the need for developing new approaches for treating depressed patients who complain of physical symptoms.

Adherence to Maintenance-phase Antidepressant Medication as a Function of Beliefs About Medication
By James E. Aikens, PhD, and colleagues
Most anti-depression medications are recommended for an extended period of treatment, so that the depression symptoms do not return. Even so, between 30% and 83% of patients stop taking their anti-depression medications before the recommended time. Patients vary widely in whether they take antidepressants for the recommended interval. In a survey of 81 patients, researchers found that patients who believed more strongly that they needed the medication, compared with their concerns about taking it, were more likely to take the drug as prescribed. Those whose concerns about taking the medication were stronger than their perceptions that they needed the drug were less likely to take the drug for the full time. Tailoring treatment by taking these beliefs into account may help patients gain the most benefit from antidepressant therapy.

The Recognition of Depression: The Primary Care Clinician's Perspective
By Seong-Yi Baik, PhD, RN
Depression can be difficult to identify, because the symptoms often are unclear and can suggest a number of health problems. This study found that primary care doctors use a range of techniques to identify depression. These include ruling out physical causes of the patient�s symptoms, encouraging the patient to talk about what is bothering them, and comparing the patient�s behavior and appearance with the way the patient is normally. Knowing the patient can help the doctor to identify a patient�s depression.

Beliefs and Attitudes Associated with the Intention to Not Accept the Diagnosis of Depression among Young Adults
By Benjamin W. Van Voorhees, MD, MPH, and colleagues
10,962 young adults aged 16 to 29 years participated in and screened positive in an Internet-based depression assessment and questionnaire. More than one quarter (26 percent) of the respondents said they did not intend to accept their physician�s diagnosis of depression. The authors uncovered a number of reasons why these respondents refused the diagnosis of depression: they disagreed that medications are effective in treating depression, disagreed that depression has a biological cause, and agreed that they would be embarrassed if their friends knew that they had depression. Negative attitudes and beliefs, social norms, and past treatment experiences may contribute to low rates of depression treatment among young adults.

Alcohol-Related Injuries: Evidence for the Prevention Paradox
By Maria C. Spurling, MD, and colleague
Contrary to common beliefs, injuries that are due to drinking alcohol are more likely to be associated with an occasion of drinking than with a dependence on alcohol. In this study of 2,517 patients admitted to 3 emergency departments between 1998 and 2000, most alcohol-associated injuries occurred in persons who drank alcohol during the 6 hours before injury. Between 8.5% and 10.6% of all injuries could be attributed to consuming alcohol in the preceding few hours. According to the authors, levels of drinking alcohol that are considered safe are frequently associated with injury. Consuming 2 or 3 alcoholic drinks for women or 2 to 4 for men caused about 4% of all emergency department injury visits in this study, about the same proportion as is caused by alcohol dependence. An even greater proportion of major injuries (between 7.6% and 9.9%) was attributed to these levels of drinking. In 2001, 29.2 million injuries were treated in US emergency departments. Of those injuries as many as 1.3 million are possibly attributable to drinking what is considered a safe amount of alcohol.

Physician Conceptions of Responsibility to Individual Patients and Distributive Justice in Health Care
By Mary Catherine Beach, MD, MPH, and colleagues
Doctors� values may be shifting as a younger generation of doctors comes to the fore, according to a survey of 372 doctors from 11 managed care organizations. The researchers found that a strong sense of responsibility to individual patients is less common among younger doctors and those who practice in staff-model managed care organizations (compared with those who practice in network-model managed care organizations). They also found that doctors with a strong sense of responsibility to individual patients were significantly more likely to report being satisfied with the quality of care they provide and with their ability to serve the needs of their patients.

Changes in Age at Diagnosis of Type 2 Diabetes Mellitus in the United States, 1998 to 2000
By Richelle J. Koopman, MD, MS, and colleagues
Diabetes is becoming more widespread in the United States. Based on a large national survey, researchers found that, from 1988 to 2000, the age at which patients had type 2 diabetes diagnosed decreased from 52 to 46 years. There could be several reasons for this. People may be getting type 2 diabetes at an earlier age, medical professionals may be detecting the disease at earlier stages, and the public may be more aware of and educated about the disease, and therefore seeking treatment earlier.

Women's Perceptions of Future Risk After Low-Energy Fractures At Midlife
By Lynn M. Meadows, PhD, and colleagues
Low-energy fractures experienced by women at midlife or later may increase their risk of future fractures and may be early signs of low bone density (osteoporosis). In this study, 22 women older than 40 years who had experienced a fracture as a result of osteoporosis in the previous year were interviewed. Most did not see their previous fracture as a sign that they were more susceptible to future fractures and did not commit themselves to long-term prevention. Most of the women�s views fell into one of 2 groups: (1) they preferred to wait and see what the future held, or (2) they recognized some of the things they should be doing to reduce their risk but were not consistent in making changes or finding information. Family physicians can play an important role in educating patients about short- and long-term bone health and actions that may prevent additional fractures.

Mental Health Research in Primary Care: Mandates from a Community Advisory Board
By Roberto Chen�, MA, and colleagues
There is growing interest in participatory research, in which people who are being studied or who are affected by the research are partners in critical aspects of the study. This collaborative approach often involves a community advisory board that guides the research project. This study describes insights from a community advisory board that provided mentoring and advice to researchers studying mental health in the primary care setting.

Practical and Relevant Self-Report Measures of Patient Health Behaviors for Primary Care Research
By Russell E. Glasgow, PhD, and colleagues
There is increasing evidence that primary care clinicians can help prevent and manage disease by counseling patients about healthy behaviors. One of the difficulties in researching disease prevention is reliably measuring health behaviors. This article identifies some of the most reliable, valid, and practical ways for researchers to assess and track 4 health behaviors: physical activity, risky drinking, eating patterns, and cigarette smoking.

The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives
By Howard Brody, MD, PhD
Practicing family physician and ethicist Howard Brody, MD, PhD, contends that because visits with pharmaceutical representatives are time-consuming and because the representatives serve interests which often are at odds with those of patients, physicians should refrain from meeting with them. Brody argues that spending time with representatives in a way that preserves professional integrity would require both refusing to accept their gifts and spending a great deal of valuable time double-checking their information to correct for the bias which may be present in representatives� presentations. He contends that given how busy most physicians are, the vast majority of physicians could better serve their patients by spending their time in other ways.