Evaluation of the Role of Training in the Implementation of a Depression Screening and Treatment Protocol in 2 Academic Outpatient Internal Medicine Clinics Utilizing the Electronic Medical Record. (July 2015)

• Record Type: Journal Article
• Authors: Loeb, Danielle; Sieja, Amber; Corral, Janet; Zehnder, Nichole G.; Guiton, Gretchen; Nease, Donald E.
• Is Part Of: American journal of medical quality. Volume 30:Number 4(2015:Jul./Aug.)
• Page Start: 359
• Page End: 366
• Publication Date: 2015-07
• Subjects: quality improvement -- primary care -- depression -- decision support -- patient-reported outcomes -- care delivery workflow -- PHQ-2 -- PHQ-9; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860614532681
• Languages: English
• ISSNs: 1062-8606

Abstract

Systematic approaches to depression identification and management are effective though not consistently implemented. The research team implemented a depression protocol, preceded by training, in 2 faculty-resident practices. Medical assistants used the Patient Health Questionnaire (PHQ)-2 for initial screening; providers performed the PHQ-9. These were documented in the electronic medical record. Logistic regression was performed to assess the association of provider type, clinic site, and training attendance with documentation of PHQ-9 after positive PHQ-2s, and with repeat PHQ-9s after positive PHQ-9s. In logistic regression analysis, training attendance was positively associated with documentation of PHQ-9 after a positive PHQ-2 (odds ratio [OR] = 2.4 [confidence interval (CI) = 1.3-4.3]) and repeated documentation of a PHQ-9 after a positive PHQ-9 (OR = 2.5 [CI = 1.1-5.3]). This study describes the successful implementation of a stepped-care approach to depression care. The positive association of training with compliance with protocol procedures indicates the importance of training in the implementation of practice change.