Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.

An examination of an open-book testing approach in a family medicine clerkship seeks to determine whether this method more closely mirrors the discipline of family medicine, where practitioners refer daily to written resource materials in order to make clinical decisions without compromising the learning and assessment process. Student scores on the multiple-choice test were analysed by year, by quarter and by site using ANOVA. Students in the experimental site were interviewed to determine preparation style, use of text during test, as well as attitudes toward open-book testing. Analysis of variance showed that the interaction of site and year was significant at p = 0.03. The mean score of 88.2 for Maine students in 2002 was significantly different from the other three mean scores. The desired qualitative outcomes of the intervention were confirmed: reducing the anxiety of students, wider reading of the textbook, knowing the structure of the textbook as a learning resource, and deeper understanding of concepts and principles rather than time spent on memorization. While the difference in scores did reach statistical significance, it is important to note that the difference in mean score was only four points on a 100-point scale. Given the percentage of the total grade represented by the test score, it is unlikely that this difference represents any real difference in grade for students in Maine compared with Vermont. The students appeared to approach the textbook and therefore, perhaps, the body of knowledge as a whole with the orientation of a generalist. The MMC Clerkship Director recommended the implementation of the open-book approach to the Family Practice clerkship at all sites and the University of Vermont Medical School accepted the proposal. This recommendation supports advising students on the preparation for an open-book test and on tactics for the best use of the textbook during the test.

PURPOSE This qualitative study examined the barriers to adopting depression care management among 42 primary care clinicians in 30 practices. METHODSThe RESPECT-Depression trial worked collaboratively with 5 large health care organizations (and 60 primary care practices) to implement and disseminate an evidence-based intervention. This study used semistructured interviews with 42 primary care clinicians from 30 practice sites, 18 care managers, and 7 mental health professionals to explore experience and perceptions with depression care management for patients. Subject selection in 4 waves of interviews was driven by themes emerging from ongoing data analysis.RESULTS Primary care clinicians reported broad appreciation of the benefi ts of depression care management for their patients. Lack of reimbursement and the competing demands of primary care were often cited as barriers. These clinicians at many levels of initial enthusiasm for care management increased their enthusiasm after experiencing care management through the project. Psychiatric oversight of the care manager with suggestions for the clinicians was widely seen as important and appropriate by clinicians, care managers, and psychiatrists. Clinicians and care managers emphasized the importance of establishing effective communication among themselves, as well as maintaining a consistent and continuous relationship with the patients. The clinicians were selective in which patients they referred for care management, and there was wide variation in opinion about which patients were optimal candidates. Care managers were able to operate both from within a practice and more centrally when specifi c attention was given to negotiating communication strategies with a clinician.CONCLUSIONS Care management for depression is an attractive option for most primary care clinicians. Lack of reimbursement remains the single greatest obstacle to more widespread adoption. Ann Fam Med 2008;6:30-37. DOI: 10.1370/afm.742. INTRODUCTION Depression is a common condition in primary care practice, 1,2 with a prevalence of 5% to 9%.1 Despite a solid evidence base for enhanced primary care of depression, [3][4][5][6][7][8][9][10][11] substantial defi cits in the adequacy of care remain. A principal component of evidence-based approaches to improving depression outcomes in primary care includes care management. 12 Although there is considerable evidence for its effectiveness in improving depression outcomes in a variety of primary care settings, [13][14][15][16] primary care clinicians have been slow to adopt care management. [17][18][19] Care management for depression consists of a combination of assessing and monitoring a patient's depression status; determining preferences, barriers, and progress; providing patient education and development of treatment and self-management plans; coordinating care with primary 18 lack of critical mass and fl exibility to assign care management roles, 19 and physician belief that depression is diffi cult to treat and of lower priority than...

Abstract Background We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality. Methods We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System. Results Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79). Conclusion Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.