***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Although effective treatment of depressed patients requires regular follow-up contacts and symptom monitoring , an efficient method for assessing treatment outcome is lacking . We investigated responsiveness to treatment , reproducibility , and minimal clinical ly important difference of the  Patient Health Question naire-9 ( PHQ-9 )  , a st and ard instrument for diagnosing depression in primary care . Methods : This study included 434 intervention subjects from the IMPACT study , a multisite treatment trial of late-life depression ( 63 % female , mean age 71 years ) . Changes in  PHQ-9 scores over the course of time were evaluated with respect to change scores of the SCL-20 depression scale as well as 2 independent structured diagnostic interviews for depression during a 6-month period . Test-retest reliability and minimal clinical ly important difference were assessed in 2 subgroups of patients who completed the PHQ-9 twice exactly 7 days apart . Results : The PHQ-9 responsiveness as measured by effect size was significantly greater than the SCL-20 at 3 months ( −1.3 versus −0.9 ) and equivalent at 6 months ( −1.3 versus −1.2 ) . With respect to structured diagnostic interviews , both the PHQ-9 and the SCL-20 change scores accurately discriminated patients with persistent major depression , partial remission , and full remission . Test-retest reliability of the PHQ-9  was excellent , and its minimal clinical ly important difference for individual change , estimated as 2 st and ard errors of measurement , was 5 points on the 0 to 27 point PHQ-9 scale . Conclusions : Well-vali date d as a diagnostic measure , the PHQ-9 has now proven to be a responsive and reliable measure of depression treatment outcomes . Its responsiveness to treatment coupled with its brevity makes the PHQ-9 an attractive tool for gauging response to treatment in individual patient care as well as in clinical research OBJECTIVES The authors examine whether physician education has enduring effects on treatment of depression . METHODS Depressed primary care patients initiating antidepressant treatment from primary care clinics of a staff-model health maintenance organization were studied . Quasi-experimental and before- and -after comparisons of physician practice s , supplemented with patient surveys , were used to compare the process of care and depression outcomes . Intervention consisted of extensive physician education that spanned a 12-month period . This included case-by-case consultations , didactics , academic detailing ( eg , clearly stating the educational and behavioral objectives to individual physicians ) , and role-play of optimal treatment . Main outcome measures were divided into two groups . Quasi-experimental sample s included : ( 1 )  antidepressant medication selection and ( 2 )  adequacy ( dosage and duration ) of pharmacotherapy .  Survey sample s included : ( 3 ) intensity of follow-up ; ( 4 )  physician delivered educational messages regarding depression treatment ;  ( 5 ) patient satisfaction ; and ( 6 ) depression outcomes . RESULTS No lasting educational effect was observed consistently in any of the outcomes measured . CONCLUSIONS There was no enduring improvement in the treatment of depression for primary care patients . Depression treatment guidelines were achieved contemporaneously , however , for intervention patients enrolled in a multifaceted program of collaborative care during the training period . These results suggest that continuing programs of reorganized service delivery to support the role of a primary care physician ( eg , on-site mental health personnel , close monitoring of patient progress and adherence ) , in addition to physician training , are essential for the success of guideline implementation 
    Output:
    
These were influenced by GPs ' experience ( years in practice ) , and perceived time spent dealing with depression ( involvement ) .
Use of the question naire enabled more experienced GPs to relinquish control , encourage patient involvement , and offer alternative sources of help .
They felt less responsible for overall care .
Less experienced , and less involved GPs found question naires  supportive through increasing their confidence in asking difficult questions , and were encouraged to look for depression , which they might previously have avoided .
Using mental health question naires helped GPs feel more confident in detecting and managing depression , and there was greater willingness to use question naires than found in previous studies .
Most GPs sought reduced responsibility in ongoing care , using question naires to involve patients and pass responsibility to them or other agencies