Acceptability of the Stepped Care Model of Depression Treatment in Primary Care Patients and Providers.

Primary care has become the first and only point of contact for a majority of individuals experiencing depressive symptoms. One alternative model of care that has been adopted in international primary care settings as an alternative to standard care is the stepped care model. Emerging evidence suggests that the stepped care model is at least as effective as standard care for depression; however, little is known about attitudes of patients and providers regarding this model, especially within the US. The current study utilized a cross-sectional survey to inquire about general attitudes towards the stepped care model, the individual steps, and the treatments offered within each step. We also examined the step that participants would prefer if prescribing or seeking help and the strength of those preferences. Descriptive and inferential statistics indicated that participants view the stepped care model as an acceptable form of treatment for depression and it is an improvement upon standard care. Results also indicated that our patient sample generally preferred self-help interventions over other treatment options, while most of our provider sample would prefer to treat patients in a manner consistent with the stepped care model. These results highlight the importance of collaboration and assessing preferences for treatment choices.

Using digital assessment technology to detect neuropsychological problems in primary care settings.

Introduction: Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks. Methods: A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on 44 individual digital clock variables across command and copy tests conditions. Results: Subjective memory concerns were endorsed by 41% of participants. Approximately 31% of participants reported psychological distress involving loneliness, anxiety, or depression. Patients with self-reported memory concerns scored lower on a combined delay 3- word/ clock drawing index (p < 0.016), the total summary clock drawing command/ copy score (p < 0.050), and clock drawing to command Drawing Efficiency (p < 0.036) and Simple and Complex Motor (p < 0.029) indices. Patients treated for diabetes and atherosclerotic cardiovascular disease (ASCVD) scored lower on selected CCE outcome measures (p < 0.035). Factor analyses suggest that approximately 10 underlying variables can explain digital clock drawing performance. Discussion: The CCE is a powerful neurocognitive assessment tool that is sensitive to patient's subjective concerns about possible decline in memory, mood symptoms, possible cognitive impairment, and cardiovascular risk. iPad administration ensures total reliability for test administration and scoring. The CCE is easily deployable in outpatient ambulatory primary care settings.

50-year-old man • foot pain • "purple" toe • history of smoking • Dx?

► Foot pain ► "Purple" toe ► History of smoking.

Lifestyle Changes for Disease Prevention.

In primary care, physicians have the opportunity to address preventative causes of morbidity and mortality. Primary care physicians have a distinct opportunity to provide counseling regarding lifestyle changes and disease prevention in a variety of settings, both during the treatment of acute illnesses and with wellness examinations. Questions from patients regarding specific recommendations and interventions are common. In this article, we address barriers to and tools to encourage lifestyle changes in the areas of smoking cessation, weight loss, physical activity, mental health, and substance abuse/misuse.