Such pressures will certainly have some impact on the willingness of GPs to change their behavior. Training primary care providers Since it is undisputable that many primary care providers have

only minimal training in the detection, treatment, and check details referral mechanisms of mental disorders, educational programs remain important in both training and practice. Such programs can at least keep providers up to date with new diagnoses, treatments, and management strategies. While other factors (time, motivation) may be important for the actual implementation, at least a very basic understanding is provided. Inhibitors,research,lifescience,medical What remains unresolved here is by what mechanisms such programs are Inhibitors,research,lifescience,medical most successfully implemented. Clearly, the endless production of guidelines is insufficient, as are continuing education programs and visits by representatives of pharmaceutical companies. Rather, we need to search for the most appropriate dissemination and translation strategies in primary care settings. More systematic research is

needed to identify factors related to formats and physicians, as well those related to organizations and financial considerations assodated Inhibitors,research,lifescience,medical with successful implementation. Clinical practice Primary care physicians’ work is subject to considerable time restrictions, in terms of the number of patients (up to 60 patients a day in some countries), the broad spectrum of all medical conditions Inhibitors,research,lifescience,medical and presenting symptoms, and the high point-prevalence of variable expressions of depressive disorders (about 10% including all types, severity, and patterns of comorbidity).7,15-49 As managed care predominates, expectations are increasing. Particularly in countries with an extremely high average numbers of patients (over 60 patients a day in Germany), the reduction in time per patient to only a few minutes on a typical day probably

forms a severe obstacle to improvement of both recognition and Inhibitors,research,lifescience,medical intervention, may it be treatment or referral. While screening tools might be partly successful in countries where GPs have at least also 10 to 15 min per patient, they are clearly of little use in countries where GPs have less than 10 min with their patients. This obstacle can only be overcome by structural changes in the organization and reimbursement schemes, because, even if simple and efficient screening tools are used, a proper differential diagnostic workup is unlikely given the GPs’ short period of time per patient. The time pressure in everyday practice is also responsible for difficulties in successful referral to mental health specialists and other more efficient interventions.19 Among models for this, the so-called collaborative model is the most popular.