Tagprimary care

Reading of the Week: Suicide and Gender in Canada; Also, Access and Immigrants (CJP), and Chok on Variations on a Theme (CMAJ)

From the Editor

This week, we have three selections; all are from Canadian publications.

Suicide rates have been declining in this country. In the first selection, Sara Zulyniak (of the University of Calgary) and her co-authors look at suicide by age and gender, drawing on almost two decades’ worth of data. In their analysis, there is a surprising finding: “The suicide rates in females aged 10 to 19 and 20 to 29 were increasing between 2000 and 2018. In comparison, no male regression results indicated significantly increasing rates.” This research letter, just published in The Canadian Journal of Psychiatry, is short and relevant.

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In the second selection, also from The Canadian Journal of Psychiatry, Joanna Marie B. Rivera (of Simon Fraser University) and her co-authors consider access to care. They focus on immigrants and nonimmigrants, noting differences in the way care is provided for those with mood disorders. “People with access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Unfortunately, immigrants, and especially recent immigrants, are more likely to see a doctor in solo practice or use walk-in clinics as a usual place of care.”

Finally, in our third selection from CMAJ, Dr. Rozalyn Chok (of the University of Alberta), a pianist who is now a resident of paediatrics, describes a performance at a mental hospital. “I still hear exactly how it sounded on that tinny upright piano. I feel the uneven weighting of the keys, remember how difficult it was to achieve the voicing – the balance of melody and harmony – I wanted.” She reflects on the piece she played, and its impact on a patient.

DG

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Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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Reading of the Week: Gawande’s New Yorker Essay on Primary Care (and, Yes, Mental Health)

From the Editor

How is health care changing?

To answer that question, we look this week not to a medical journal, but to The New Yorker. We consider an essay not on new drugs or imaging, but on the quiet rise of… primary care.

Primary care and the future

Dr. Atul Gawande writes a long essay on the virtues of primary care. Considering how medicine has shifted from acute care to chronic illness, he describes the importance of primary care, drawing on his own training and thinking – and the cardiac issues of his son.

Though this essay doesn’t directly consider mental illness, it is very relevant.

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