Literature Collection

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.

Integrated systems of care are increasingly seen as the means to bridge gaps between organisations, services and professions, increase quality, and decrease costly duplication across the health and care landscape. Integration and integrated health and care teams, composed of locality-oriented health and social care practitioners, have become central to global health policies. Integrated teams are expected to share distinct bodies of knowledge, evidence and expertise and use this to create holistic care plans. However, little research has examined how they achieve these knowledge-related goals. This research uses organisational knowledge creation theory to examine the discursive practices within integrated teams. Observational data from case management meetings across five integrated teams highlight four key themes: (1) Instrumental questioning dominated discussions, often making participants feel criticised and leading to the imposition of questioners' opinions. (2) Interactions were typically unstructured and unreflective, hindering clear objectives and limiting knowledge sharing and creation. (3) Teams often failed to retain and apply prior learning, struggling to identify cross-case insights. (4) Teams relied heavily on internal knowledge sources, rarely seeking evidence from patients, families or other professionals. These discursive practices undermine the policy goals of integrated care, particularly with regard to knowledge and evidence. To address this, teams need support to expand the forms of knowledge and evidence they draw upon, discuss contradictions and uncertainties, and value reflective, curiosity-driven dialogue.