Background Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients’ management of depressive symptoms, physical activity levels, and diabetes-related outcomes. Methods 291 patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥14)were recruited from a community-university-and VA healthcare system. A manualized telephone CBT program was delivered by nurses weekly for 12weeks, followed by nine monthly booster sessions. Sessions initially focused exclusively on patients’ depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1cmeasured at 12-months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health related quality of life (HRQL) were measured using standardized scales. Results Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a4.26 mmHg decrease in systolic blood pressure relative to controls (p=.05). Intervention patients had significantly greater increases in step-counts (mean difference 1,131 steps/day; p=.0002) and greater reductions in depressive symptoms (58%remitted at12 months versus 39%; p=.002). Intervention patients also experienced relative improvements in coping and HRQL. Conclusions This program of telephone delivered CBT combined with a pedometer-based walking program did not improve A1c values but significantly decreased patients’ blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients’ functioning and quality of life.

Integrated behavioral health in primary care has spread rapidly over the past three decades, although significant questions remain unanswered regarding best practices in clinical, financial and operational worlds. Two key models have emerged over time: care management and Primary Care Behavioral Health. Research to date has been promising; however, there is a significant need for more sophisticated multi-level scientific methodologies to fill in the gaps in current knowledge of integrated primary care. In this paper, we summarize current scientific knowledge about integrated primary care and critically evaluate the strengths and weaknesses of this knowledge base, focusing on clinical, financial and operational factors. Finally, we recommended priorities for future research, dissemination, real-world implementation, and health policy implications.

This study evaluates role expectancies in essential nursing services of nursing home professionals and relatives of residents. Whereas previous studies have indicated substantial role ambiguity, the present research indicates significant agreement between the groups. Even so, areas exist where families deem themselves responsible for a task, but staff expectations are incongruent. Analysis of this process and steps to ameliorate this problem are discussed.

Psychologists are presented with unprecedented opportunities to integrate their work in primary care settings. Although some roles of psychologists in primary care overlap with those in traditional psychology practice settings, a number are distinct reflecting the uniqueness of the primary care culture. In this paper, we first describe the integrated primary care setting, with a focus on those settings that have components of patient centered medical home. We then describe functional roles and foundational characteristics of psychologists in integrated primary care. The description of functional roles emphasizes the diversity of roles performed. The foundational characteristics identified are those that we consider the 'primary care ethic,' or core characteristics of psychologists that serve as the basis for the various functional roles in integrated primary care. The 'primary care ethic' includes attitudes, values, knowledge, and abilities that are essential to the psychologist being a valued, effective, and productive primary care team member.