Teaching systems-based practice to primary care physicians to foster routine implementation of evidence-based depression care.

Although health care organizations seeking to improve quality often must change the system for delivering care, there is little available evidence on how to educate staff and providers about this change. As part of a 2002-2003 Veterans Health Administration multisite project using collaborative care to improve the management of depression, the authors implemented the Translating Initiatives for Depression into Effective Solutions (TIDES) program. Five steps were followed for teaching systems-based practice: (1) determine providers' educational needs (through administrative data, expert opinion, and provider discussion), (2) develop educational materials (based on needs assessed), (3) help each of seven sites develop an educational intervention, (4) implement the intervention, and (5) monitor the intervention's effectiveness. Sites relied primarily on passive educational strategies. There was variable implementation of the different components (e.g., lecture, educational outreach). No site chose to write up its education plan, as was suggested. The authors thus suggest that the educational model was successful at identifying providers' needs and creating appropriate materials, because the program was not advertised in other ways and because almost all providers referred patients to the program. However, the educational model was only partially successful at getting sites to develop and implement an educational plan, although provider behavior did change. Overall, the program was somewhat effective at teaching systems-based practice. The authors believe the best way to enhance effectiveness is to build education into the system rather than rely on a separate system for education.

Developing a bioterrorism preparedness campaign for veterans: Using focus groups to inform materials development.

In the context of a global war on terrorism experts have focused on the potential for a bioterrorist incident to cause widespread health and psychological consequences. Preparation is critical to improving the U.S. response to future bioterrorist incidents and educating the public is recognized as a vital part of this preparedness effort. Under a grant from the U.S. Veterans Health Administration (VHA), researchers from a network of VA health care and research facilities initiated a program to develop and evaluate educational materials for veterans--including those with mental illness. This article describes the results of a series of focus groups with three veteran subpopulations of interest to characterize their concerns and information needs and summarizes the insights gained that helped guide materials development.