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There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services-including tobacco cessation screening, alcohol abuse screening, and daily aspirin use-against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million lifeyears annually. What's more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.

PURPOSE Depression is associated with lowered work functioning, including absences, impaired productivity, and decreased job retention. Few studies have examined depression symptoms across a continuum of severity in relationship to the magnitude of work impairment in a large and heterogeneous patient population, however. We assessed the relationship between depression symptom severity and productivity loss among patients initiating treatment for depression. METHODS Data were obtained from patients participating in the DIAMOND (Depression Improvement Across Minnesota: Offering a New Direction) initiative, a statewide quality improvement collaborative to provide enhanced depression care. Patients newly started on antidepressants were surveyed with the Patient Health Questionnaire 9-item screen (PHQ-9), a measure of depression symptom severity; the Work Productivity and Activity Impairment (WPAI) questionnaire, a measure of loss in productivity; and items on health status and demographics. RESULTSWe analyzed data from the 771 patients who reported being currently employed. General linear models adjusting for demographics and health status showed a signifi cant linear, monotonic relationship between depression symptom severity and productivity loss: with every 1-point increase in PHQ-9 score, patients experienced an additional mean productivity loss of 1.65% (P <.001). Even minor levels of depression symptoms were associated with decrements in work function. Full-time vs part-time employment status and self-reported fair or poor health vs excellent, very good, or good health were also associated with a loss of productivity (P <.001 and P = .045, respectively).CONCLUSIONS This study shows a relationship between the severity of depression symptoms and work function, and suggests that even minor levels of depression are associated with a loss of productivity. Employers may fi nd it benefi cial to invest in effective treatments for depressed employees across the continuum of depression severity. Ann Fam Med 2011;9:305-311. doi:10.1370/afm.1260. INTRODUCTIOND epression is prevalent and incurs substantial indirect costs associated with reduced work functioning, including absences, impaired productivity, and even decreased job retention across a wide variety of occupations. [1][2][3][4] In addition, several studies have shown that even minor or subthreshold depression (including dysthymia) is related to poorer work performance. 5,6 Fewer studies have examined depression symptoms across a continuum of severity in relationship to the magnitude of work loss that includes both absences and impaired productivity. Simon et al 7 found that among outpatients treated for bipolar disorder, depression severity was strongly and consistently associated with a decreased probability of employment and more days of absence due to illness. Backenstrass et al 8 characterized a spectrum of depressive symptoms across 3 increasing levels of severity (nonspecifi c, minor, and major) and found an increasing number of days of absence due t...

Key Points Question How long does blood pressure remain lower compared with usual care after a 12-month intensive intervention (home telemonitoring and pharmacist management)? Findings In this follow-up of a cluster randomized trial of 326 patients with uncontrolled hypertension, research clinic measurements showed that home blood pressure telemonitoring with pharmacist management lowered blood pressure more than usual care in the first 18 months, but this was not sustained through 54 months. The results from routine clinical measurements suggested significantly lower blood pressure in the intervention group for up to 24 months. Meaning Long-term maintenance strategies may be needed to sustain blood pressure intervention effects over several years.