Between one and two thirds of depressive disorders go undetected in primary care settings. Four hundred ninety-six Mexican American primary care patients from high-poverty areas were screened for depressive symptoms, and 41% endorsed depressive symptoms. Eighty percent of screened patients with depressive symptoms agreed to structured diagnostic interviews and 90% of those interviewed met diagnostic criteria for one or more depressive disorders. Cases of depression detected through this systematic process were compared with evidence of depression detected by providers in medical charts. Provider and study evaluation agreement was poor (kappa= 0.13); providers noted depression in 21% of patients with depressive disorders based on the systematic evaluation. More work is needed to enhance detection of depression in primary care, especially in minority populations.

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The need to identify and improve access to evidence-based treatments for depressive disorders and other mental health problems is a public health priority, particularly in relation to racial/ethnic minorities and other underserved groups. One hundred forty-six Mexican American primary care patients who met diagnostic criteria for major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified (NOS) were offered eight sessions of an evidence-based behavioral treatment, problem-solving treatment for primary care (PST-PC). Among participants who agreed to treatment (N=117), depressive symptom scores decreased over time; a minority of participants completed four or more sessions of PST-PC (N=55), and those participants had greater decreases in depressive symptom severity than participants who completed three or fewer PST-PC sessions (N=62) (Hopkins Symptom Checklist-20 scores declined on average 0.86+/-0.97 and 0.40+/-0.66 points for these groups, respectively, p<.05). More work is needed to enhance the engagement in treatments for depression, especially among Latinos in primary care.

The expert panel report version 2 (EPR-2) is a comprehensive set of recommendations for the evaluation and treatment of asthma. However, physicians demonstrate scant adoption of many of the key evaluation and treatment components of the EPR-2, with primary care physicians being less likely to adopt EPR-2 recommendations than specialist physicians. Patients also demonstrate very limited adoption of physician recommendations, such as the use of medications as prescribed. Predictors of physician and patient nonadherence are reviewed, as modifiable predictors may be targets for interventions to enhance adherence. Finally, areas for future efforts are identified.

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