Primary Health Care Clinicians Research Articles

Guidelines for nutrition counseling in primary healthcare clinics

Background: Chronic diseases are a significant burden on the healthcare system. Nutrition counseling plays a pivotal role in the management and prevention of chronic diseases. Despite its importance, primary healthcare clinicians face practical challenges in providing effective nutritional guidance owing to time limitations, lack of information, and resistance of patients.Current Concepts: This review identifies the main barriers to nutrition counseling that are encountered by primary healthcare clinicians. We propose general strategies to overcome these obstacles, emphasizing the need for simple and easy approaches in clinical settings. In addition, specific one-point counseling methods according to gender and age that can be applied in various situations, techniques related to behavior change for motivating and guiding patients, and practical tips to cope with common conditions such as diabetes, hypertension, and obesity are also discussed. Additionally, utilization of education materials, apps, and websites as convenient resources for patients is highlighted.Discussion and Conclusion: Real-life cases demonstrated successful application of nutrition counseling in clinical practice that benefitted both the patients and clinicians. This review suggests enhancing nutrition education in medical schools and residency programs, along with activating nutrition counseling fees to motivate and support clinicians. In conclusion, this review reaffirms the importance of nutrition counseling and stresses the need for continuous learning and practice by clinicians. In the future, nutrition counseling is envisioned as a more integrated and patient-centered approach, necessitating active engagement and adaptation by primary healthcare providers.

Early identification of cow’s milk protein allergy in infants in Kirkuk, Iraq, using milk-related symptom scores

Abstract Background: Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders. Cow’s milk protein allergy (CMPA) is the most common food allergy, especially in infancy and childhood, which may persist into adulthood. Objectives: The aim of this study was to evaluate the effect of cow’s milk protein allergy (CMPA) in infants in its early identification using CMPA scoring system. Materials and Methods: We carried out an observational study at Azadi teaching Children’s Hospital’s pediatric gastrointestinal clinic from March to December 2021. Children seen in our pediatric GI clinic between the ages of 1 and 12 months were included. Infants with suspected CMPA were evaluated by cow’s milk-related symptom score (CoMiSS) tool. An allergic reaction, a gastrointestinal, respiratory, or dermatologic presentation, excluding an acute infectious disease, and at least one of the following conditions were required for a diagnosis of suspected CMPA. All participating doctors received the required training on CoMiSS, the oral challenge test procedure, and CMPA diagnosis and treatment guidelines before subject recruitment. Results: In this study, most of studied infants were men, and no significant difference between CMPA and non-CMPA infants regarding sex, age, and weight was found. In this study, 17.85% of infants with CMPA score suffered from occult blood in their fecal samples compared with 11.15% of non-CMPA infants (P < 0.05). In this study, most of infants with CMPA have score 12, and the mean was 13.65 and the maximum value was 18. Conclusions: The CMPA score system provides primary healthcare clinicians with a simple, fast, and easy-to-use awareness tool for cow’s milk-related symptoms.

Routine developmental screening in Australian general practice: a pilot study

BackgroundParents’ Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations.MethodsThe study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners.ResultsDocumented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners’ motivation to use PEDS tools and perceptions of environmental constraints.ConclusionsA team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices.

Screening, diagnosing and management of Pacific peoples with prediabetes in New Zealand primary healthcare clinics with high concentrations of Pacific peoples: an online survey.

Introduction Prediabetes is a condition of elevated blood sugar levels which can increase the risk of type 2 diabetes (T2D) if not managed effectively. Prediabetes is likely to affect about 24.6% of New Zealand (NZ) adults, with estimates of 29% of the Pacific population currently living with the condition. A prediabetes diagnosis is an opportunity for intervention from trusted primary care providers. The study aim was to describe primary healthcare clinician's knowledge and practice regarding screening, diagnosing and management of prediabetes in Pacific patients. Methods An online survey was conducted with current practicing primary healthcare clinicians between February and April 2021. Eligible participants included clinicians employed in a primary healthcare clinic with over 50% of enrolled patients identified as Pacific. Results Primary healthcare clinicians (n = 30) reported that their prediabetes screening, diagnosis and management were aligned with the NZ Ministry of Health clinical guidelines. The most common factors that prompted screening was a family history of T2D (25/30, 83%), ethnicity (24/30, 80%) weight and BMI (24/30, 80%). The initial management practices involved providing recommendations for dietary changes and physical activity (28/30, 93%) and referring patients to a diabetes prevention lifestyle change programme (16/30, 53%). Discussion Primary healthcare clinicians are the foremost point of engagement with patients and their fāmili (family) in their health journey. Culturally appropriate tools could be useful to assist healthcare providers to communicate to a higher risk population and most clinicians rely on up to date guidelines for screening and management.

Improving primary care for Aboriginal and Torres Strait Islander people with rheumatic heart disease: What can I do?

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) disproportionately affect Aboriginal and Torres Strait Islander people in Australia, with devastating impacts on morbidity, mortality and community wellbeing. Research suggests that general practitioners and primary care staff perceive insurmountable barriers to improving clinical outcomes, including the need for systemic change outside their scope of practice. The aim of this article is to identify constructive, micro-level strategies that primary healthcare clinicians can consider, adopt and sustainably use to improve care for people with ARF and RHD in their routine clinical practice. Through skilled clinical care, reflection and culturally safe practices, individual primary healthcare clinicians have substantial capacity to improve care experiences and outcomes for Aboriginal and Torres Strait Islander people and communities affected by ARF and RHD.

Comparing the effectiveness of competition as a method of reminding primary oral health care dentists to record diagnoses with two alternative methods used to enhance the recording of diagnoses in primary health care

ABSTRACT The purpose of this study was to investigate whether competition is an effective method to remind primary oral health care dentists to record diagnoses (RRD). The effectiveness of competition was examined in comparison with financial group bonuses (FGBs) and electronic reminders (ERs) of the electronic health record, together with superior-subordinate or development discussions. Putative differences in the diagnosis recording cultures of Finnish public health care physicians and dentists were studied. This was a retrospective quasi-experimental observational study in which the effects of the interventions on the rate of recording diagnoses were identified using a general linear regression model and proportions of visits with recorded diagnoses. The rate of increase in the recording of diagnoses in dentists was 0.995 ± 0.273%/month (mean ± SEM) after the implementation of RRDs and this did not differ from that obtained after starting FGBs (0.919 ± 0.130%/month) or ERs with superior-subordinate or development discussions (1.562 ± 0.277%/month) in physicians. As the rates of increase did not differ none of the applied methods seemed to be more effective than the others when trying to influence the behaviour of primary health care clinicians. Altogether, public primary health care physicians were more active than respective primary oral health care dentists to record diagnoses.

Effect of hearing loss on cognitive function in patients with mild cognitive impairment: A prospective, randomized, and controlled study.

BackgroundHearing loss (HL) may increase the risk of cognitive decline in the elderly. However, the randomized controlled study on the effect of HL on cognitive function in mild cognitive impairment (MCI) is very limited.MethodsFrom 1 November 2020 to 30 March 2022, 1,987 individuals aged 55–65 years were randomly divided into the MCI with hearing impairment (MCI-HI), MCI without HI (MCI-nHI), and no MCI (nMCI) groups by stratified sampling, with 30 participants in each group. The Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the pure tone audiometry (PTA), and the auditory brainstem response (ABR) were measured at baseline and a follow-up 12 months later. The trial protocol was registered with ClinicalTrials.gov with the registration number NCT05336942.ResultsAmong the 90 participants, the average age was 60.41 ± 6.48 years. In the MCI-HI group at baseline, the PTA score of both the ears was negatively correlated with the naming and memory score (p < 0.05), and the PTA score of both the ears was negatively correlated with the MoCA and abstraction score at the 12-month follow-up (p < 0.05). However, there were no significant differences among the PTA, the ABR, the MMSE, and the MoCA scores in the MCI-nHI and nMCI groups (p > 0.05). Regression analysis showed that the PTA score of the right ear at baseline was an important factor associated with the MoCA, visuospatial/executive, naming, and abstraction scores at the 12-month follow-up (β = −0.776 to −0.422, p < 0.05).ConclusionHL was significantly negatively associated with cognitive function only in patients with MCI with hearing impairment (HI), and the PTA of the right ear may be a predictor of cognitive decline after 1 year in patients with MCI with HI. This information may help primary healthcare clinicians to prevent MCI by screening and intervening in care for elderly patients with HL.

Prognostic biomarkers in cardiovascular diseases

The use of biomarkers as a reliable and reproducible indicative of the risk, severity, and progression of cardiovascular diseases (CVDs) may greatly enhance the prognostic capability of primary healthcare clinicians. In primary healthcare, the realistic and wise use of reliable biomarkers could minimize the time and costs for effective diagnosis and suitable personalized therapy for CVD patients. Therefore, the aim of the present scoping review is to evaluate the prognostic significance of biomarkers in the progression and monitoring of CVDs. The review was conducted according to the PRISMA-ScR guidelines. Eight databases were searched for articles published as of June 2021 using search terms: cardiovascular diseases AND biomarkers AND prognosis. A total of 21 studies were included in this scoping review. This review identified biomarkers BNP, cTnT yielded better accuracy of disease progression prediction in ACS and HF respectively. The availability of CVDs prognostic biomarkers in primary healthcare clinics could promote improved clinical outcomes of patients.

Community-informed, integrated, and coordinated care through a community-level model: A narrative synthesis on community hubs

We identify the core services included in a community hub model of care to improve the understanding of this model for health leaders, decision-makers in community-based organizations, and primary healthcare clinicians. We searched Medline, PubMed, CINAHL, Scopus, Web of Science, and Google from 2000 to 2020 to synthesize original research on community hubs. Eighteen sources were assessed for quality and narratively synthesized (n = 18). Our analysis found 4 streams related to the service delivery in a community hub model of care: (1) Chronic disease management; (2) mental health and addictions; (3) family and reproductive health; and (4) seniors. The specific services within these streams were dependent upon the needs of the community, as a community hub model of care responds and adapts to evolving needs. Our findings inform the work of health leaders tasked with implementing system-level transformations towards community-informed models of care.

Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study

BackgroundChildren and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities.ObjectiveThe objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services.MethodsWe developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program.ResultsDuring the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions.ConclusionsThe telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.

Implementing a weight-specific quality-of-life tool for young people in primary health care: a qualitative study.

BackgroundObesity is thought to be one of the most serious global public health challenges of the 21st century. The primary care setting is important in terms of the diagnosis, education, and management of obesity in children and young people. This study explored the views of primary care clinicians on the implementation of a quality-of-life (QoL) tool to help young people and their families identify the impact of weight on QoL.AimTo assess the acceptability and feasibility of implementing the Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) QoL tool for young people aged 11–18 years in primary care.Design & settingQualitative study in Northern England, UKMethodOne-to-one, semi-structured interviews were conducted with a purposive sample of primary healthcare clinicians working in practices located in areas of varying deprivation in Northern England, UK. Interview transcripts were coded and analysed using framework analysis in NVivo (version 10).ResultsParticipants (n = 16 GPs; n = 4 practice nurses) found the WAItE tool acceptable for them and their patients, and believed it was feasible for use in routine clinical practice. It was important to primary care clinicians that the tool would provide an overall QoL score that would be easy for GPs and nurses to interpret, to help them identify patients most in need of specialist help.ConclusionThis study has developed a platform for further research around QoL in young people who are overweight and obese. A future feasibility study will focus on implementing the tool in a small number of primary healthcare practices.

Leveraging electronic health records to improve management of noncommunicable diseases at primary healthcare centres in Saudi Arabia: a qualitative study

BackgroundElectronic Health Records (EHRs) can contribute to the earlier detection and better treatment of chronic diseases by improving accuracy and accessibility of patient data. The Saudi Ministry of Health (MOH) implemented an EHR system in all primary health care clinics (PHCs) as part of measures to improve their performance in managing chronic disease. This study examined the perspective of physicians on the current scope and content of NCDs management at PHCs including the contribution of the EHR system.MethodsSemi-structured interviews were conducted with 22 physicians working in chronic disease clinics at PHCs covering a range of locations and clinic sizes. The participants were selected based on their expertise using a combination of purposive and convenience sampling. The interviews were transcribed, analyzed and coded into the key themes.ResultsPhysicians indicated that the availability of the EHR helped organise their work and positively influenced NCDs patient encounters in their PHCs. They emphasised the multiple benefits of EHR in terms of efficiency, including the accuracy of patient documentation and the availability of patient information. Shortcomings identified included the lack of a patient portal to allow patients to access information about their health and lack of capacity to facilitate multi-disciplinary care for example through referral to allied health services. Access to the EHR was limited to MOH primary healthcare centres and clinicians noted that patients also received care in private clinics and hospitals.ConclusionWhile well regarded by clinicians, the EHR system impact on patient care at chronic disease clinics is not being fully realised. Enabling patient access to their EHR would be help promote self-management, a core attribute of effective NCD management. Co-ordination of care is another core attribute and in the Saudi health system with multiple public and private providers, this may be substantially improved if the patients EHR was accessible wherever care was provided. There is also a need for enhanced capacity to support improving patient’s nutrition and physical activity.

School Bullying and Association with Somatic Complaints in Victimized Children

To examine the relationship between peer victimization and psychosomatic symptoms among school-going children. A total of 213 school-going children (Mean = 11.49 y, SD = 1.44) studying in grades 5 to 8 were recruited from 2 schools from a north Indian city. The children were administered the California Bullying Victimization Scale (CBVS), Pre-Adolescent Adjustment Scale (PAAS), and the Children's Somatization Inventory (CSI). The total score on the somatization inventory and the total number of psychosomatic symptoms endorsed were used as the main outcome measures. Out of the 213 students, 42.7% were involved in bullying either as victims or as perpetrators. A little more than one-fourth (26.8%) were victims. A consistent positive association between victimization and somatic complaints was found. The most common physical symptoms reported by victims included headache (60.7%), chest pain (35.7%), stomach pain (33.9%), weakness (30.4%), and pain in arms and legs (19.6%). Stepwise multiple regression analysis revealed that 22.6% of the variance in the total CSI scores was accounted by the total victimization score, self-reported adjustment with school teachers, and academic performance (F = 20.97, P = 0.0001). The total number of functional somatic symptoms were predicted by the total victimization score, academic performance, and age of the child (F = 16.03, P = 0.0001). These variables together predicted 18% of the variance in the total number of symptoms. Primary health care clinicians and pediatricians need to consider bullying as one of the potential risk factors when they encounter physical symptoms among pediatric patients in their clinical practice.

Primary healthcare clinicians' positive perceptions of the implementation of telehealth during the COVID-19 pandemic using normalisation process theory.

The objective of the study was to measure implementation of telehealth for client consultations from Allied Health and Community Health clinicians' perspectives during the COVID-19 pandemic. Purposeful sampling was used to invite allied and community health clinicians to complete the survey. An online survey design, underpinned by normalisation process theory, utilising the NoMAD tool, which consists of 19 implementation assessment items. Descriptive statistics are reported. A 66% (n =24) response rate was obtained. Fifty-two percent indicated they were using telehealth for the first time. Despite the rapid implementation of telehealth for client consultations due to the pandemic crisis, participants reported positive perceptions of the use of telehealth when measured using the NoMAD. Fifty-eight percent (n =14) of respondents agreed or strongly agreed that telehealth will become a normal part of their work. Despite unplanned and under-resourced implementation of telehealth, Allied Health and Community Health clinicians reported very positive perceptions. However, further education and training to ensure 'normalisation' of this model may be required.

Participatory Action Research Applied to an Ear, Nose, and Throat Specialty Service Redesign in Remote Australia: A Mixed-Methods Study of Key Stakeholder Perspectives.

This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible educational gaps in clinical knowledge. This was followed by an internal stakeholder forum and a follow-up survey with Torres and Cape Hospital and Health Service staff to gain their perspectives on current service delivery and table ideas for a new ENT health service model. Qualitative data were analyzed inductively and grouped in emerging themes. Quantitative data were imported into tables and analyzed descriptively. PAR allowed for input from 19 PHC clinicians, 10 face-to-face stakeholders perspectives, and 18 stakeholder follow-up survey respondents. Four themes emerged: 1. Training for health workers in ENT management; 2. Improved local service access; 3. New referral pathways to improve continuity of care; and 4. Introduction of telehealth. PAR engaged key stakeholders, identifying gaps in ENT service delivery, and guided the development of the new service model. The inclusion of stakeholders throughout the service redesign process is likely to create a more sustainable model of care which already has local “buy-in”.

Prioritisation of diabetes-related footcare amongst primary care healthcare professionals.

To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care. DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation. A cross-sectional quantitative study reported according to STROBE statement. General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey. On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20-year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n=73) of participants and podiatry referrals a priority for 53% (n=50) of participants only when a "foot concern" was raised. Referrals to specialist high-risk foot podiatrists or services were a first priority for 56% (n=53), when the person had significant amputation risk factors. Diabetes-related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD. This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.

In Support of Community-based Primary Health Care: Coping with the COVID-19 Crisis.

In Support of Community-based Primary Health Care: Coping with the COVID-19 Crisis.

Factors Associated with Tooth Loss in Postmenopausal Women: A Community-Based Cross-Sectional Study.

Many studies have indicated that menopause affects periodontal health and tooth loss. The possible mechanism might due to several hormonal changes and low bone mineral density (BMD) during the transition period. However, few studies have explored the role of oral hygiene in the number of remaining teeth (NRT) in postmenopausal women (PMW). The aim of this study was to explore the prevalence of and factors associated with NRT less than 20 in PMW. A community-based, cross-sectional study was conducted in coastal Yunlin County, Taiwan. NRT was calculated based on natural and filled teeth. BMD was detected by dual-energy X-ray absorptiometry at the collaborating hospital. Logistic regression analyses were used to identify the factors associated with NRT in rural PMW. Six hundred and ten rural PMW with mean age 65.4 years enrolled in this study. The mean NRT was 17.6 (standard deviation [SD] = 10.4), with 43.9% having <20 and 13.9% edentulous. More than half (65.9%) reported that they seldom brushed their teeth after meals, 79.2% rarely used dental floss, and 80% did not regularly undergo tooth scaling by a dentist. The majority of women had low BMD, including 48.7% with osteopenia and 20.7% with osteoporosis. After adjusting for potentially confounding variables, NRT <20 was associated with infrequent tooth scaling (odds ratio [OR] = 2.78, 95% confidence interval [CI] = 1.70–4.56) and dental floss use (OR = 2.01, 95% CI = 1.24–3.26), but not BMD. A high prevalence of NRT <20 was found among rural PMW, but poor oral hygiene rather than low BMD was the major contributing factor. It is an emerging issue for primary healthcare providers and clinicians to initiate oral hygiene promotion programs for these disadvantaged women.

Assessment and management of minor burns in children.

Approximately 1% of the Australian and New Zealand population seeks medical assistance for a burn injury each year, and many patients presenting with burns are children. Minor burns that do not meet referral criteria can be managed by the family general practitioner (GP). If there are any concerns about the injury or progress of the burn wound healing, GPs are encouraged to contact their local burns service for advice. The aim of this article is to provide primary healthcare clinicians with a summary of the acute management of minor burns in children. Effective first aid for burns will minimise burn progression and alleviate pain. Appropriate wound care will promote optimal healing and potentiate favourable outcomes. Although a minor burn may not meet initial referral criteria for transfer to a specialised burn centre, GPs are encouraged to refer if there are any concerns in relation to wound healing, pain management or scarring, or if consultative advice regarding management is required.

Measuring Primary Health Care Clinicians’ Skills for Depression Management

Introduction: Primary health care clinicians play an important role in the management of depression. Thus, it is very important to have a valid and reliable assessment of the competences needed to manage depression in primary health care, with the use of clinical simulation providing such an opportunity. Objective: The present study describes the assessment of primary health care clinicians’ depression-related skills through a series of objective structured clinical examination stations. Material and Methods: Clinicians from multi-professional teams for the management of depression at two primary health care clinics in Santiago, Chile, went through seven objective structured clinical examination stations, lasting 10 to 20 min each, to assess their depression-related skills. The clinical and communicative skills measured were in accordance with clinical guidelines. Standardized patients portrayed cases usually encountered in clinical practice, while expert raters evaluated clinicians’ performance with standardized checklists. Results: Psychosocial clinicians performed better than biomedical clinicians in the assessed skills. The most notable results were as follows: a high level of accomplishment in the relationship with patient, medical anamnesis, health checkup, and lab test requests; heterogeneous performance in patient management according to screening results, feedback to the patient, and registration in clinical records; and major deficiencies in the differential diagnosis of bipolar disorder. Discussion: The objective structured clinical examinations administered provided an opportunity to perform an in-depth examination of the depression-related skills of primary health care clinicians, where flaws in the screening and diagnosis procedures used by biomedical clinicians were detected. Given the significant involvement of these types of clinicians in depression management, undergraduate-level and continuing health education opportunities are needed.