The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System : A Cohort Study
BACKGROUND: Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes.
OBJECTIVE: To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment.
DESIGN: Retrospective pre-post study.
PARTICIPANTS: Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded.
INTERVENTION: Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016.
MAIN MEASURES: Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment.
KEY RESULTS: Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90 days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01).
CONCLUSIONS: Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.
Errataetall: |
CommentIn: J Gen Intern Med. 2020 Nov;35(11):3420. - PMID 32779133 |
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Medienart: |
E-Artikel |
Erscheinungsjahr: |
2020 |
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Erschienen: |
2020 |
Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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Enthalten in: |
Journal of general internal medicine - 35(2020), 11 vom: 03. Nov., Seite 3141-3147 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Pfoh, Elizabeth R [VerfasserIn] |
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Links: |
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Anmerkungen: |
Date Completed 14.05.2021 Date Revised 02.11.2021 published: Print-Electronic CommentIn: J Gen Intern Med. 2020 Nov;35(11):3420. - PMID 32779133 Citation Status MEDLINE |
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doi: |
10.1007/s11606-020-05856-5 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM310747473 |
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500 | |a CommentIn: J Gen Intern Med. 2020 Nov;35(11):3420. - PMID 32779133 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a BACKGROUND: Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes | ||
520 | |a OBJECTIVE: To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment | ||
520 | |a DESIGN: Retrospective pre-post study | ||
520 | |a PARTICIPANTS: Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded | ||
520 | |a INTERVENTION: Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016 | ||
520 | |a MAIN MEASURES: Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment | ||
520 | |a KEY RESULTS: Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90 days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01) | ||
520 | |a CONCLUSIONS: Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a depression | |
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700 | 1 | |a Anand, Amit |e verfasserin |4 aut | |
700 | 1 | |a Martinez, Kathryn A |e verfasserin |4 aut | |
700 | 1 | |a Katzan, Irene |e verfasserin |4 aut | |
700 | 1 | |a Rothberg, Michael B |e verfasserin |4 aut | |
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