Quality Of Depression Care Research Articles

The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes

This longitudinal study of patients with diabetes examined the relationship between changes in depressive symptoms and changes in diabetes self-care behaviors over 5 years. A total of 2759 patients with diabetes enrolled in a large HMO were followed over a 5-year period. Patients filled out a baseline mail survey and participated in a telephone interview 5 years later. Depression was measured with the Patient Health Questionnaire (PHQ-9) and diabetes self-care was measured with the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Baseline and longitudinal evidence of diabetes and medical disease severity and complications were measured using ICD-9 and CPT codes and verified by chart review. At the 5-year follow-up, patients with diabetes with either persistent or worsening depressive symptoms compared to those in the no depression group had significantly fewer days per week of following a healthy diet or participating in > or = 30 min of exercise. At 5-year follow-up, patients with clinical improvement in depression symptoms showed no differences compared to the no depression group on number of days per week of adherence to diet but showed deterioration in adherence to exercise on some, but not all, measures. Patients with diabetes with persistent or worsening depressive symptoms over 5 years had significantly worse adherence to dietary and exercise regimens than patients in the no depression group. These results emphasize the need to further develop and test interventions to improve both quality of care for depression and self-care in diabetes patients.

Integrating Practices’ Change Processes into Improving Quality of Depression Care

Primary care practices would benefit from improved understanding of how to make and sustain fundamental changes in their delivery systems. An improvement collaborative project was conducted in 2005 to not only improve the quality of depression care but help participating practices adopt and adapt more effective change processes to implement improved depression care. In a follow-up to an article on the project's impact in terms of measurable, sustained improvements in depression care, an exploratory qualitative study was conducted to examine primary care practices' adoption of effective change processes. Qualitative data were collected from 16 primary care practices participating in the National Depression Management Leadership Initiative's Improving Depression Care project. A multistep process of qualitative analysis was used to identify exemplar practices, and a constant comparative method was applied to identify salient features that influenced adoption of change processes associated with improvements in depression care during the course of the 18-month project. The participating practices showed considerable variability in terms of the improvements they made in depression care and corresponding adoption of change processes to help make these and other improvements. Nearly all practices that showed the greatest improvements in depression care also adopted more effective processes for change, with several features associated with exemplar practices able to improve depression care and change processes. These findings support the thesis that successful quality improvement efforts should address both clinical content and change processes. They also add to the literature on the impact of improvement collaborative projects, which to date have demonstrated mixed effects in a variety of chronic diseases, including depression.

Recorded quality of care for depression in general practice: an observational study

Depression is a leading cause of disease and disability internationally, and is responsible for many primary care consultations. Little is known about the quality of primary care for depression in the UK. To determine the prevalence of good-quality primary care for depression, and to analyse variations in quality by patient and practice characteristics. Retrospective observational study. Eighteen general practices in England. Medical records were examined for 279 patients. The percentage of eligible participants diagnosed with depression who received the care specified by each of six quality indicators in 2002 and 2004 was assessed. Associations between quality achievement and age, sex, patient deprivation score, timepoint, and practice size were estimated using logistic regression. There was very wide variation in achievement of different indicators (range 1-97%). Achievement was higher for indicators referring to treatment and follow-up than for indicators referring to history taking. Achievement of quality indicators was low overall (37%). Quality did not vary significantly by patient or practice characteristics. There is substantial scope for improvement in the quality of primary care for depression, if the highest achievement rates could be matched for all indicators. Given the lack of variation by practice characteristics, system-level and educational interventions may be the best ways to improve quality. The equitable distribution of quality by patient deprivation score is an important achievement that may be challenging to maintain as quality improves.

Organizational Cost of Quality Improvement for Depression Care

We documented organizational costs for depression care quality improvement (QI) to develop an evidence-based, Veterans Health Administration (VA) adapted depression care model for primary care practices that performed well for patients, was sustained over time, and could be spread nationally in VA. Project records and surveys from three multistate VA administrative regions and seven of their primary care practices. Descriptive analysis. We documented project time commitments and expenses for 86 clinical QI and 42 technical expert support team participants for 4 years from initial contact through care model design, Plan-Do-Study-Act cycles, and achievement of stable workloads in which models functioned as routine care. We assessed time, salary costs, and costs for conference calls, meetings, e-mails, and other activities. Over an average of 27 months, all clinics began referring patients to care managers. Clinical participants spent 1,086 hours at a cost of $84,438. Technical experts spent 2,147 hours costing $197,787. Eighty-five percent of costs derived from initial regional engagement activities and care model design. Organizational costs of the QI process for depression care in a large health care system were significant, and should be accounted for when planning for implementation of evidence-based depression care.

Quality of Depression Care and Its Impact on Health Service Use and Mortality Among Veterans

Little is known about the effects of quality of depression care on patient outcomes other than depression status. This study examined Veterans Health Administration (VHA) data over a six-year period to determine whether quality of depression care was related to patients' health service use and mortality. Using a national VHA database, the authors identified 205,165 veterans with a new-onset depressive disorder and at least one filled prescription for an antidepressant medication between October 1, 1999, and September 30, 2005. Quality of depression care was assessed with antidepressant medication possession ratios and adequacy of follow-up care (three or more depression-related visits during the 84 days after a depression diagnosis). Logistic regression modeling was used to predict inpatient service use and all-cause mortality. Of the cohort 48% received an adequate supply of antidepressant medication and 31% had three or more follow-up visits during the 84-day profiling period. Rates of adequate medication supply did not change over the six-year period, but there were improvements in adequate follow-up care over the study period (p=.03). Adequate follow-up depression care was associated with increased health service use and decreased likelihood of 12-month all-cause mortality. According to the quality indicators, less than half of patients with newly diagnosed depression received high-quality care. Notably, adequate follow-up care for depression was significantly related to reduction in odds of patient mortality at the 12-month follow-up. These findings suggest that quality of depression care may significantly affect patient outcomes, including mortality, and that further efforts to improve quality appear warranted.

Quality of Depression Care and Its Impact on Health Service Use and Mortality Among Veterans

Quality of Depression Care and Its Impact on Health Service Use and Mortality Among Veterans

Primary Care Physicians' Evaluation and Treatment of Depression

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics.

Relationship Between the Presence of Practice Systems and the Quality of Care for Depression

A valid measure of practice systems for improving chronic disease care is needed as a guide for both improvement and public accountability. We tested whether a new survey measure of the presence of practice systems (the PPC-R) is associated with performance measure rates for depression among 40 medical groups in Minnesota. These PPC-R scores were compared with standardized medical group measures of antidepressant persistence. Only 54% of potentially important systems were present, and there was high variability. However, there was a positive correlation between systems and quality on the 90-day measure of antidepressant persistence, both overall (r = .33, P = .04) and for the Chronic Care Model domains of decision support (r = .38, P = .02) and delivery system redesign (r = .31, P = .05). Thus, practice systems overall and several domains of the Chronic Care Model appear to be associated with higher quality care for depression. This questionnaire may help practices identify particular systems to improve.

Quality of depression care for people with coincident chronic medical conditions

Objective Depression is common and associated with poor outcomes for people with chronic medical conditions (CMCs). The goals of this study were (1) to determine the effect of CMCs on the use and quality of depression care and (2) to understand whether the patient–provider relationship mediates the relationship between CMCs and depression care quality. Method With the use of data from the 1997–1998 National Survey of Alcohol, Drug, and Mental Health Problems (Healthcare for Communities), the relationships between CMCs, depression recognition, receipt of minimally adequate depression care and the patient–provider relationship were assessed with multivariate linear and logistic regression models for 1309 adults who met criteria for major depressive disorder. Results Depressed patients with a CMC were more likely to have their depression recognized by a provider (OR=2.10; 95% CI=1.32–3.35) and to take antidepressant medications (32% vs. 19%, P=.02) than those without a CMC. However, having a CMC was not associated with receiving minimally adequate depression care or patient satisfaction. Depression recognition was associated with number of medical visits (OR=1.12; 95% CI=1.09–1.15), having a usual source of care (OR=3.57; 95% CI=2.26–5.63), and provider trust (OR=1.07; 95% CI=1.04–1.11). Conclusion Depressed people with a comorbid CMC are more likely to have their depression recognized than those without a CMC, though were no more likely to receive minimally adequate depression care. Aspects of the patient–provider relationship, including trust and continuity of care, may help to explain the increased rate of depression recognition among patients with severe CMCs.

Screening and case-finding instruments for depression: a meta-analysis

Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference -0.02, 95% CI -0.25 to 0.20). If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified.

Quality of Mental Health Care for Depressed Adolescents

Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of quality care compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders.

Improving Medication Management of Depression in Health Plans

Improving depression treatment is critical given low rates of appropriate care. Health plan performance measures that address quality of antidepressant medication management, specifically, have been stagnating at relatively low levels. Identifying health plan characteristics associated with better performance could contribute to quality improvement for this aspect of depression treatment. Data for 2003 were linked from two sources: a nationally representative survey of 368 health plans about their behavioral health services and the National Committee for Quality Assurance's Health Plan Employer Data and Information Set (HEDIS) antidepressant medication management (AMM) scores, which reflect the percentage of eligible members whose care met specified criteria. The analytic sample present in both data sets totaled 361 products offered by 183 plans. Plan characteristics were grouped into organizational, provider, and consumer domains. Bivariate tests and regression analyses were conducted to estimate the relationship between these characteristics and health plan performance on three AMM measures: effective acute-phase treatment, effective continuation-phase treatment, and optimal practitioner contact. Mean HEDIS AMM scores were 60% for effective acute-phase treatment, 43% for continuation-phase treatment, and 22% for optimal practitioner contact. Individual feedback to clinicians about their performance, lower cost sharing for outpatient mental health, and greater access to selective serotonin reuptake inhibitors were significantly associated with better plan performance in terms of antidepressant medication management. Health plan characteristics were significantly associated with the quality of one important aspect of depression care, antidepressant medication management. Many of the factors that were identified suggest actionable ways for plans to improve quality of depression care.

Prevalence and Treatment of Diagnosed Depression among Elderly Nursing Home Residents in Ohio

To examine the prevalence and treatment of diagnosed depression among elderly nursing home residents and determine the resident and facility characteristics associated with diagnosis and treatment. Documented depression, pharmacotherapy, psychotherapy, sociodemographics, and medical characteristics were obtained from Ohio's Minimum Data Set for 76 735 residents in 921 nursing homes. The data were merged with Online Survey Certification and Reporting System data to study the impact of facility characteristics. Chi-squared statistics were used to test group differences in depression diagnosis and treatment. Multiple logistic regressions were used to examine the prevalence of diagnosed depression, and among those diagnosed, of receiving any treatment. There were 48% of residents who had an active depression diagnosis; among those diagnosed, 23% received no treatment; 74% received antidepressants; 0.5% received psychotherapy; and 2% received both. African Americans, the severely cognitively impaired, and those in government facilities were less likely to be diagnosed. Residents aged 85 and older, African Americans, individuals with severe mental illness, those with severe ADL or cognitive impairment, and individuals living in a facility with 4 or more deficiencies were less likely to receive treatment. Significant disparities exist both in diagnosis and treatment of depression among elderly residents. Disadvantaged groups such as African Americans and residents with physical and cognitive impairments are less likely to be diagnosed and treated. Our results indicate that work needs to be done in the nursing home environment to improve the quality of depression care for all residents.

Primary Care Docs Get Depression Report Card

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPrimary Care Docs Get Depression Report CardJun YanJun YanSearch for more papers by this authorPublished Online:19 Oct 2007https://doi.org/10.1176/pn.42.20.0019A substantial number of patients with depression are diagnosed and treated by primary care providers in community settings. A recent study found that patients have better outcomes when these physicians closely follow treatment guidelines. The study—published in the September Annals of Internal Medicine—also found that, although the majority of primary care physicians did well in following recommendations for screening and treatment initiation, they tended to miss the mark in assessing comorbidities and suicide risk and making therapeutic adjustments or referrals to psychiatrists or mental health professionals when patients did not respond well to treatment.Kimberly Hepner, Ph.D., an associate behavioral scientist at the RAND Corp., and colleagues analyzed surveys of more than 1,000 patients with depression who were treated in the primary care setting and measured the quality of care against Agency for Healthcare Research and Quality (AHRQ) guidelines. The data were collected during a Quality Improvement for Depression project from 1996 to 1998, in which 45 primary care practices within four health care organizations (including a family practice network, Kaiser Permanente, Veterans Affairs, and a network-model managed care organization) in 13 states were involved in collaborative quality-improvement activities. In the project, researchers identified patients at these sites who met criteria for depression and recorded details about the care the patients received through follow-up telephone interviews for the next two years.This current study, funded by the National Institute of Mental Health, AHRQ, the MacArthur Foundation, and Department of Veterans Affairs, analyzed the care activities, ranging from initial diagnosis to follow-up treatment, provided by the physicians over two years from the survey and patient-outcome data.Because of a lack of quantitative instruments for measuring quality of depression care, the authors developed a set of 20 quality indicators based on the AHRQ depression care guidelines and validated this index. After comparing patient-care survey responses with the quality indicators, they found that the primary care physicians followed AHRQ guidelines the most closely in basic patient education, attention to depression during the acute phase, and providing appropriate initial treatment for individual patient complaints (all above 80 percent, see chart); the least-followed indicators were alcohol-use assessment, suicide assessment, appropriate treatment for elderly patients, and treatment for suicidal ideation in patients not already treated by mental health providers (all below 30 percent).“We conducted this study to provide a conceptual model for future research in quality of depression care,” said Lisa Rubenstein, M.D., coauthor of the study and director of the Veterans' Administration Greater Los Angeles/University of California at Los Angeles/RAND Center for the Study of Healthcare Provider Behavior, in an interview with Psychiatric News.“ Our study is the first to measure the broad range of aspects in depression care, while controlling for case mix. We wanted to encourage primary care practitioners to adhere to guidelines.”The study results supported the clinical effectiveness of adhering to the AHRQ guidelines, with the findings showing that patients tended to have better outcomes when their primary care providers stuck to the guidelines. The findings appeared to confirm the effectiveness of evidence-based, expert-synthesized treatment guidelines.“Primary care physicians talk to their patients about depression and follow up in the early phase [after diagnosis], but many are not able to perform intensive assessments of patients' comorbidities and treatment adjustments if the patient does not respond,” said Rubenstein on the barriers to better adherence to guidelines. “A full depression assessment takes 20 to 40 minutes, which can't be done in a 15-minute office visit or with lab tests.” She suggested practical approaches, such as training nurses and other personnel to perform evaluations, as a way to improve the quality of depression treatment in primary care settings.An abstract of “The Effect of Adherence to Practice Guidelines on Depression Outcomes” is posted at<www.annals.org/cgi/content/abstract/147/5/320>.▪ ISSUES NewArchived

Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations

A systematic review of 11 randomised, economic evaluations examining clinical and cost effectiveness of organisational interventions aimed at improving the quality and outcome of care for depression in primary care identified five key interventions:

Disparities in depression care in managed care settings

The implementation of managed health care two decades ago produced sweeping changes in the delivery of health care. A large number of patients who have depression are cared for in managed care settings. Despite the fact that managed health care programs have offered the advantage of affordable and effective treatment of depression to many patients, racial and ethnic minorities remain underdiagnosed and undertreated. Diagnosis of depression, prescribing of antidepressant therapy, and referral for psychotherapy occur significantly less often in minority patients compared with whites. In the managed care setting, a number of issues at the physician level may negatively affect the quality of depression care, including attitudes toward psychiatry and mental health services, unfamiliarity with best practice guidelines for depression, and lack of cultural competency. On the other hand, a number of innovative approaches (eg, collaborative care) have demonstrated effectiveness in managed care settings. In some cases, physician education can be integrated with these approaches to assist health care providers in managed care organizations to provide the best possible depression care. This article focuses on issues relevant to depression care of minorities in the managed care sector, cites strategies for improving quality of depression care, and discusses implications for CME.

How quality improvement interventions can address disparities in depression

The quality of depression care, especially care received by minorities, needs improvement. Several interventions have been developed for the purpose of improving the quality of depression management in primary care, including quality improvement strategies employing disease management approaches, the chronic care model, and the Breakthrough Collaborative Series developed by the Institute for Healthcare Improvement. This article reviews these interventions and examines their potential to contribute to the improvement of depression care.

Costs and consequences of enhanced primary care for depression

A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings. We conducted a systematic review of all full economic evaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix. We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from 7 ($13, no confidence interval given) to 13 UK pounds ($24,95% CI -105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit. Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment.

The Association of Patient Relationship Style and Outcomes in Collaborative Care Treatment for Depression in Patients With Diabetes

We sought to determine whether relationship style in patients with diabetes receiving depression treatment is associated with differential quality of care and depression outcomes. From 9 health maintenance organization clinics, 324 primary care patients with diabetes and comorbid major depression and/or dysthymia participated in the Pathways randomized controlled trial of collaborative care for depression (n = 160) versus usual care (n = 164). The intervention provided outreach, enhanced support of antidepressant medication use, and problem-solving treatment delivered by nurse case managers. Using attachment theory principles, we categorized patients as having an independent (n = 190) or interactive (n = 134) relationship style. We assessed whether patient relationship style moderated treatment group differences in quality of care and depression outcomes. Among independent relationship style patients, the intervention resulted in significantly greater satisfaction with depression care in the first 6 months and 47 more depression-free days (P < 0.0003) based on the Hopkins Symptom Checklist at 12 months, compared with usual care. There were no significant treatment group differences in satisfaction with care or depression outcomes among patients with interactive relationship style. Among patients receiving the intervention, those with an independent relationship style received significantly more problem-solving treatment sessions as compared with patients with an interactive relationship style. Among depressed patients with diabetes, the Pathways collaborative care intervention improved quality of care for depression compared with usual care in both relationship style groups but was associated with significantly better depressive outcomes and greater satisfaction with care compared with usual care in patients with independent but not interactive relationship style.

Economic Incentives Increase Access to Depression Care

Back to table of contents Previous article Next article From the PresidentFull AccessEconomic Incentives Increase Access to Depression CareSteven Sharfstein, M.D.Steven SharfsteinSearch for more papers by this author, M.D.Published Online:6 Jan 2006https://doi.org/10.1176/pn.41.1.0003Employer-based health insurance is the major means by which we pay for health care in America.For years APA has been a leader, through its Business Initiative and the American Psychiatric Foundation's Partnership for Workplace Mental Health, in working with employers to alert them to the morbidity associated with untreated mental illness in the workplace, particularly depression.The economic losses associated with absenteeism and with reduced productivity of depressed employees have led many employers to advocate for better insurance coverage and incentives for the treatment of depression. Based in part on pressure from employers, the Aetna Company, one of the world's largest insurance companies, has decided to pay increased fees for primary care physicians to screen patients for depression and to provide follow-up care for patients who are then started on anti-depressant medications.In this program, severely depressed patients may be referred by the primary care physician to a psychiatrist for care. The depression screening involves a written test and the Patient Health Questionnaire (PHQ-9), which was developed at Columbia University and tested in a variety of settings. Physicians participating in the Aetna program are in six states and will be paid 30 percent to 40 percent more for a routine visit when the depression screening questionnaire is used.Since family physicians and other primary care doctors write an estimated two-thirds of prescriptions for antidepressants in the United States and are often the gate-keepers for referral to psychiatrists and mental health professionals, this Aetna program, which will be carefully evaluated, is an important breakthrough in providing financial support for depression treatment. With nearly half of lost productivity in the United States attributed to major depression, with an estimated cost of $44 billion annually, this Aetna program will be carefully reviewed by other major payers, HMOs, and employer groups, as well as professional organizations such as APA. (To learn more about how APA is working to improve quality by working with the business community, see Viewpoints column by Norman Clemens, M.D., on Original article: page 20).Of course, any such study of treatment costs or savings cannot lose sight of the key concern, which is making sure that each patient gets the depression treatment that is best for him or her. Antidepressants are often seen as the first-line treatment, as they are in the Aetna program. However, many well-designed studies show that psychotherapy, especially cognitive-behavioral therapy, is also beneficial for patients with depression and that cognitive therapy is as effective as antidepressant medication for milder depression. A study by Robert DeRubeis, Ph.D., and colleagues in the April 4, 2005, Archives of General Psychiatry showed that cognitive therapy can be as effective as medication for initial treatment of moderate to severe depression, although cognitive therapy requires a high level of therapist expertise.The APA practice guideline for treatment of depression emphasizes that the choice of treatment depends on patient preference and the specialized skills of clinicians. The presence of significant psychosocial stressors, intrapsychic conflict, interpersonal difficulties, or comorbid Axis II conditions indicate a need for psychotherapy as well as medication treatment.Why are economic incentives encouraging depression treatment so important? We know that, depending on the study, only between 5 percent and 40 percent of depressed patients seen in primary care receive appropriate treatment and follow-up. In the U.S. comorbidity study, only one-third of people with depression received any care at all. According to burden-of-illness studies, by 2020 depression will be the leading cause of disability worldwide.APA is working to improve the quality of depression treatment across health care settings through projects such as the National Depression Management Leadership Initiative of the American Psychiatric Institute for Research and Education—a collaboration between APA, the American Academy of Family Physicians, and the American College of Physicians—to increase the availability and quality of depression care through standardized use of the PHQ-9 (Psychiatric News, June 3, 2005).Other efforts include the APA Business Initiative's partnership with the Kansas City employer coalition on the Community Initiative on Depression, which leveraged the business community to address care for depression delivered not only in primary care settings, but oncology and cardiology as well (Psychiatric News, May 6, 2005).The Aetna program is a leader in turning a spotlight on effective and early diagnosis and treatment for this major medical/psychiatric condition. You can be sure that APA will study the results of this initiative with great interest. ▪ ISSUES NewArchived