Knowledge and Behavior of Primary Care Physicians Regarding Utilization of Standardized Tools in Screening and Assessment of Anxiety, Depression, and Mood Disorders at a Large Integrated Health System.

INTRODUCTION: Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians' knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices. METHODS: The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians' demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics. RESULTS: Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (P < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (P = .26) and Mood Disorders (P = .05). CONCLUSIONS: Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.

Acute Gastrointestinal Bleeding: A Report of Rare Presentation of Duodenal Metastasis From Cervical Squamous Cell Carcinoma.

We report a case of a 42-year-old gravida 3, para 4 woman from Puerto Rico with a history of cervical cancer who presented with dizziness, lethargy, and three days of bright red blood per rectum. Imaging evaluation showed a retroperitoneal lymph node mass with secondary metastasis to the duodenum. After she was stabilized with multiple blood transfusions and to mitigate her ongoing bleeding, she was transferred to a tertiary care hospital for possible embolization by interventional radiologists. However, she was deemed a poor candidate for an interventional procedure and decided to ultimately go home on hospice care. This case highlights the rarity of duodenal metastasis presenting as gastrointestinal bleeding due to cervical squamous cell cancer and further reinforces the need for human papillomavirus vaccination and cervical cancer screening. This case study also illustrates that even though cervical cancer rates are low in the United States, it is still deadly in many countries across the globe. As people continue to travel and migrate across borders, the risk of being lost to follow-up is on the rise.