Background:The levels of breast and cervical cancer screening in Nebraska primary care remain suboptimal despite awareness of their importance, and despite implementation of the Every Woman Matters program to assist low-income women. The GAPS model was used to develop a practice-based intervention to identify and reduce barriers to delivery of breast and cervical cancer screening services.Methods: Seven primary care practices actively participated in this multimethod case study. A research nurse collected data and facilitated the intervention process at each site. Qualitative data from field notes, patient encounters, and in-depth interviews of physicians and key informants were collected to describe the process of Papanicolaou and mammogram service delivery, and to identify barriers/facilitators to screening, and potential change areas. Chart reviews provided information regarding the preintervention and postintervention identification/execution of Papanicolaou smears and mammograms. Qualitative and quantitative analyses led to individual practice case studies. Cross case comparisons identified common themes.Results: The individual practice plans for change had many commonalities, ie, developing screening databases and reminder systems. The biggest differences involved practice contexts. Despite use of the GAPS model and a financial incentive to obtain "buy in" from providers and staff, change was difficult for all but 2 of the practices.

Active-duty military personnel face deterrents to seeking outpatient mental health treatment despite the high prevalence of posttraumatic stress disorder (PTSD) in this population. The Behavioral Health Consultation (BHC) model may be the answer for those presenting subthreshold PTSD symptoms, at high risk for PTSD due to their occupation, not interested in outpatient mental health treatment, or unable to seek such treatment due to occupational limitations. Three empirically based interventions that have been effective in managing symptoms of PTSD are summarized and then integrated into the established BHC model as suggested treatments for managing PTSD symptoms in an integrated primary care setting. Pilot data and recommendations for future research and practice are provided.

Participation rates could be enhanced in future clinical trials by using a visual presentation to explain and describe the study as part of the informed consent process. More research is needed to test alternate methods of obtaining informed consent.