Nonetheless, the intervention improved medication compliance and satisfaction with care in all patients. A different approach provided physician treatment guidelines for their http://www.selleckchem.com/products/PLX-4032.html primary care patients with depression.46 Consistent with

the general literature on guideline adaptation, physician education alone resulted in greater recognition of depression, but not adequate treatment among those identified as depressed. PROSPECT’S guideline management intervention, like the physician-focused model, targets physician and patient Inhibitors,research,lifescience,medical adherence to treatment guidelines. Like the collaborative model, a specialist is integrated into the primary care setting, but in this case the specialist has the task of collaborating with the physician and increasing recognition of depression and adherence to specific treatment guidelines. An advantage of the guideline management model for elderly patients is

that it is expected Inhibitors,research,lifescience,medical to increase both the acceptability to patients and usefulness to practices. In studies of primary care Inhibitors,research,lifescience,medical patients, the vast majority of depressed patients report preferring to receive help for emotional distress by their primary care physician as opposed to a mental health specialist.47 Further, when primary care patients are referred to mental health specialists, as many as half do not reach the specialist.48,49 These findings

in mixedage groups might be even stronger in an elderly population as community studies report more negative attitudes towards mental health specialists among older than younger adults.50 From the physician’s perspective, guideline management Inhibitors,research,lifescience,medical keeps control of patient treatment in the hands of the primary care physician. As the majority of primary care physicians prefer treating their depressed patients themselves rather Inhibitors,research,lifescience,medical than referring them to others,43 this approach is expected to be more acceptable to physicians, which if found feasible, increases the likelihood of its being adopted into general practice. The difference between an intervention that facilitates the use of a guideline to identify and treat depression rather than prescribes the treatment for patients enrolled in the study is analogous to the difference within controlled 3-mercaptopyruvate sulfurtransferase treatment trials in analyses of intcnt-to-trcat patients compared with treated patients. PROSPECT aims to test the effect of the intervention on reducing suicide risk in a sample of all practice patients, not just those who following the steps of the treatment algorithm. The analysis, however, will need to examine the extent to which the primary care physicians did adhere to the guideline’s recommendations and the fidelity of the health specialist to the intervention prescribed by the intervention.