Improving research on primary care patients with mental health problems: observations from an investigator

BACKGROUND AND AIMS OF THE MANUSCRIPT: The purpose of this manuscript is to define under-recognized perspectives that the primary care research field needs to integrate into research initiatives, and to discuss practical strategies to ensure the successful implementation of these initiatives. METHODS: Perspectives and strategies were identified through personal experience, informal discussion with ten senior investigators in the field and a selected literature review. RESULTS: Research on improving treatment for the mental health problems of primary care patients will progress more rapidly if investigators explore the usefulness of a competing demands framework, integrate a readiness to change perspective in developing more individualized interventions for providers and patients, evaluate interventions for their effect on productivity and test alternative interventions particularly in patients who fail to benefit from currently accepted treatment. The implementation of these initiatives will be more successful if research teams define unique scientific agendas, invest energy in pursuing questions whose value is undisputed by multiple parties, increase the rate of inter-institutional exchange between senior and junior investigators, pilot test assumptions that affect project budget and timeline, build in a limited amount of slack time in early phases of project implementation and network effectively. IMPLICATIONS FOR FURTHER RESEARCH: Investigator efforts to define critical questions for the primary care management of mental health problems will be enhanced if they revisit the definition of their research agendas in the light of new perspectives that are emerging in the field. Similarly, the implementation of these agendas will be strengthened if investigators make conscious attempts to use one or more of the strategies suggested.