A structured approach to detecting and treating depression in primary care: VitalSign6 project

Manish K. Jha, Bruce D. Grannemann, Joseph M. Trombello, E. Will Clark, Sara Levinson Eidelman, Tiffany Lawson, Tracy L. Greer, A. John Rush, Madhukar H. Trivedi

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)326-335
Number of pages10
JournalAnnals of family medicine
Issue number4
StatePublished - Jul 1 2019


  • Antidepressants
  • Depression
  • Health care delivery/HSR
  • Loss to follow-up
  • Major depressive disorder
  • Measurement-based care
  • Primary care issues
  • Primary health care
  • Quality improvement
  • Quality of care

ASJC Scopus subject areas

  • Family Practice


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