Conversely, to the extent that the PROSPECT intervention is successful, the study will have sufficient data to develop and then test hypotheses about the most critical components. Primary care

sites To evaluate the impact of its intervention on patient outcomes, PROSPECT is collecting data from 18 separate primary care practices from 3 geographic areas (metropolitan and Inhibitors,research,lifescience,medical outlying New York, Philadelphia, and Pittsburgh). Practices were selected in pairs sharing CP-868596 manufacturer similar characteristics in terms of academic affiliation, location (urban, suburban, or rural), size (number of physicians), and the racc/cthnicity of the patients. All practices serve both managed-care and fee-for-service patients. As seen in Table I, the 9 pairs of practices Inhibitors,research,lifescience,medical represent

considerable diversity including both academic and nonacademic urban practices, a wide range in patient racial/ethnic composition, including both academic and nonacademic practices with greater than 50% minority patients, and solo as well as large group practices. Table I. Characteristics of PROSPECT physician practices (n=18). The generalizability of PROSPECT Inhibitors,research,lifescience,medical findings to primary care throughout the United States is limited to some extent by the fact that practices were not randomly selected and are all located in the northeast. On the other hand, the heterogeneous characteristics of the recruited practices and their patients do extend the representative of PROSPECT findings beyond much previous research that was limited to academic-affiliated settings, predominately white patients, or single locations. In the Inhibitors,research,lifescience,medical United States, the vast majority (74%) of elderly adults live in a metropolitan area (1990 Census),51 lending further generalizability

to findings from the study. Within each pair, practices were randomly selected Inhibitors,research,lifescience,medical to receive the guideline management intervention or “enhanced care,” a less intense intervention consisting primarily of physician education and depression identification. Although acknowledging that identification of depression is an important part of clinical care, PROSPECT is not designed to evaluate different methods of identifying depression in primary care, for several reasons. First, previous research has shown that identification of depression in primary care alone has little effect on patient outcomes. nearly Second, in order to evaluate the effect of the proposed intervention on patient outcomes, comparable assessment is needed in both intervention and usual care patients, necessitating integrating assessment into the research protocol. And third, for ethical reasons, physicians in both groups need to be informed of the results of these assessments, making a test of identification of depression by physicians nonfeasible in the context of the current study.