Developing effective collaboration between primary care and mental health providers

Objective: Improving care for depressed primary care (PC) patients requires system-level interventions based on chronic illness management with collaboration among primary care providers (PCPs) and mental health providers (MHPs). We describe the development of an effective collaboration system for an ongoing multisite Department of Veterans Affairs (VA) study evaluating a multifaceted program to improve management of major depression in PC practices. Method: Translating Initiatives for Depression into Effective Solutions (TIDES) is a research project that helps VA facilities adopt depression care improvements for PC patients with depression. A regional telephone-based depression care management program used Depression Case Managers (DCMs) supervised by MHPs to assist PCPs with patient management. The Collaborative Care Workgroup (CWG) was created to facilitate collaboration between PCPs, MHPs, and DCMs. The CWG used a 3-phase process: (1) identify barriers to better depression treatment, (2) identify target problems and solutions, and (3) institutionalize ongoing problem detection and solution through new policies and procedures. Results: The CWG overcame barriers that exist between PCPs and MHPs, leading to high rates of the following: patients with depression being followed by PCPs (82%), referred PC patients with depression keeping their appointments with MHPs (88%), and PC patients with depression receiving antidepressants (76%). The CWG helped sites implement site-specific protocols for addressing patients with suicidal ideation. Conclusion: By applying these steps in PC practices, collaboration between PCPs and MHPs has been improved and maintained. These steps offer a guide to improving collaborative care to manage depression or other chronic disorders within PC clinics.     

Dental services advertising: does it affect consumers?

Dental services advertising appears to be increasing. Despite their negative attitude toward advertising, as many as 20% of all dentists may now be advertising to meet changing conditions in a highly competitive market. Research on dental services advertising has provided a useful starting point for developing dental advertising strategies. However, it affords little understanding of how consumers may respond to the many types of information provided in dental services advertisements. The authors extend knowledge in this area by examining consumer response to dental advertising in an experimental setting.     

Cirrhosis: US images with narrow band filtering

A new type of ultrasound (US) image was created by first recording unfiltered, backscattered ultrasonic amplitudes to a standard dynamic range prior to narrow band digital filtration of the ultrasonic signal and mapping of the resultant filtered ultrasonic envelope amplitudes. Unlike unfiltered images, those created by narrow band digital filtration permit differentiation between phantoms with different scattering characteristics and normal from cirrhotic human liver in vivo. Significantly different image statistics for normal and cirrhotic liver (P less than .002) were demonstrated in preliminary clinical trials.