Depression is a prevalent illness with risk for many deleterious outcomes if under-recognized or undertreated. Depression is a leading cause of work-related disability worldwide. Most people with depression are employed (an estimated 68%). Recognizing and initiating depression care in the workplace will facilitate depression treatment in clinical settings.

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For at least 5 years the anesthesiology department serving 2 nonprofit Memorial hospitals in Modesto and Ceres, California, was internally at war, a war which spilled out into the other departments of the 2 hospitals, and actually endangered the credentialing of the institutions. Eventually the hospital staff's Medical Executive Committee and the Board of Directors decided to solve the problem by closing the department and contracting with an anesthesiology service to provide exclusive services. A legal action was filed by 3 physicians who had previously been on staff but who were not rehired by the contractor under the new administration. The defendants included the hospital, the anesthesiology contractor, and various physicians affiliated with the hospitals and the contractor. The trial court found for the defendants, and the case summarized below (Major v Memorial Hospital Association) is the Court of Appeals review [1]. The case highlights the impact a physician and hospital can have on both quality of patient care and hospital stability.11. Redding v St. Francis Medical Center, supra.

18556 Background: A demonstration project testing the feasibly of implementing a depression screening work flow algorithm was initiated by the anti-depression committee at one of six ambulatory care sites in the Kansas City Cancer Center (KCCC) system. The object of the study was to develop a process of work flow that would assist in identifying patients with depression and facilitate appropriate interventions by providers. Methods: A flow chart was developed illustrating critical decision-making points in the screening for depression by physicians and nurse practitioners (NP). The population included half radiation therapy and the other half chemotherapy. Patients completed the PHQ-2 a two question prescreen to assess initial symptoms of depression, including feeling depressed, down or hopeless and/ or little interest or pleasure in activities. A positive response to one of these 2 questions prompted the administration of the PHQ-9 a validated depression screening instrument. The PHQ-9 scoring criteria was used to assist the physician and NP with taking the appropriate action such as the initiation of antidepressant therapy and/or referral to mental health provider, follow up for subsequent appointments and/or reassessment. Results: Seventy-one patients were tracked to evaluate the process of recognition and management of depression from April 2004 to January 2005. Of the 71 patients 37% (N = 26) scored positive on at least one question on the two question prescreen. Of the 26 patients scoring positive 27% (N = 7) of these patients had less than 3 follow up visits while 73 % (N = 19) had greater than 3 follow-up visits by the KCCC providers. Of the patients that answered positively to one of the two prescreen questions 69% (N = 18) completed the full PHQ-9 and their scores were recorded. Conclusions: The development of a new model in a community-based oncology practice allows for integrating clinically proven techniques for diagnosing and treating depression. It will allow for the committee to make recommendations for changes in the process before it is implemented on a larger scale at all KCCC outpatient sites. No significant financial relationships to disclose.