The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

STEOARTHRITIS IS THE MOSTcommon type of arthritis among older adults. 1 Its prevalence increases sharply with age. About one third of individuals older than 65 years experience symptomatic osteoarthritis of the knee, and almost 80% of persons have degenerative joint disease after age 70 years. [2][3][4] Arthritis is a leading cause of disability for older persons, reduces quality of life, and accounts for one eighth of all restricted activity days. 5,6 The combined medical and economic costs associated with arthritis are staggering, posing a significant public health problem. 1,7 Depression is also common among older persons, with a prevalence of

The study blends methods from health services and clinical research in an effort to protect internal validity while maximizing the generalizability of results to diverse health care systems. We hope that this study will show the cost-effectiveness of a new model of care for late life depression that can be applied in a range of primary care settings.

The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.

Aims-To examine whether a multifaceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. Design-Randomized controlled trial.Setting-Three primary care sites in southern California.Participants-Six hundred thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were randomly assigned between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks.Measurements-The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (4 or more drinks in a day) in the past 7 days and risk score.. Conclusions-A multifaceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months.