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

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:35

Enthalten in:

Journal of general internal medicine - 35(2020), 11 vom: 03. Nov., Seite 3141-3147

Sprache:

Englisch

Beteiligte Personen:

Pfoh, Elizabeth R [VerfasserIn]
Janmey, Isabel [VerfasserIn]
Anand, Amit [VerfasserIn]
Martinez, Kathryn A [VerfasserIn]
Katzan, Irene [VerfasserIn]
Rothberg, Michael B [VerfasserIn]

Links:

Volltext

Themen:

Depression
Journal Article
Primary care
Quality improvement

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

doi:

10.1007/s11606-020-05856-5

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM310747473