TY - JOUR
T1 - A structured approach to detecting and treating depression in primary care
T2 - VitalSign6 project
AU - Jha, Manish K.
AU - Grannemann, Bruce D.
AU - Trombello, Joseph M.
AU - Clark, E. Will
AU - Eidelman, Sara Levinson
AU - Lawson, Tiffany
AU - Greer, Tracy L.
AU - Rush, A. John
AU - Trivedi, Madhukar H.
N1 - Funding Information:
Author affiliations: Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trom-bello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush) Funding support: This report was funded by Center for Depression Research and Clinical Care, The Rees-Jones Foundation (Trivedi, MH - PI), the Meadows Foundation, and the Hersh Foundation (Trivedi, MH - PI).
Funding Information:
The VitalSign6 program was funded in part by the Center for Depression Research and Clinical Care (CDRC), the Rees-Jones Foundation, the Meadows Foundation, and the Hersh Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the various funding organizations.
Publisher Copyright:
© 2019, Annals of Family Medicine, Inc. All Rights Reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - PURPOSE This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving lowincome populations, and 2 private clinics serving patients with either Medicare or private insurance). METHODS Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged =12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160). RESULTS Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement- based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age. CONCLUSION Although remission rates are high in those with 3 or more followup visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.
AB - PURPOSE This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving lowincome populations, and 2 private clinics serving patients with either Medicare or private insurance). METHODS Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged =12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160). RESULTS Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement- based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age. CONCLUSION Although remission rates are high in those with 3 or more followup visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.
KW - Antidepressants
KW - Depression
KW - Health care delivery/HSR
KW - Loss to follow-up
KW - Major depressive disorder
KW - Measurement-based care
KW - Primary care issues
KW - Primary health care
KW - Quality improvement
KW - Quality of care
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U2 - 10.1370/afm.2418
DO - 10.1370/afm.2418
M3 - Article
C2 - 31285210
AN - SCOPUS:85069291545
SN - 1544-1709
VL - 17
SP - 326
EP - 335
JO - Annals of family medicine
JF - Annals of family medicine
IS - 4
ER -