A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project.

Thumbnail Image
View / Download645.69 KB

Date

2019-07

Authors

Journal Title

Journal ISSN

Volume Title

Repository Usage Stats

69
views
35
downloads

Citation Stats

Attention Stats

Abstract

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 low-income 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 follow-up visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.

Type

Journal article

Department

Description

Provenance

Subjects

Humans, Mass Screening, Remission Induction, Retrospective Studies, Depression, Depressive Disorder, Major, Adolescent, Adult, Aged, Middle Aged, Patient Dropouts, Primary Health Care, United States, Female, Male, Young Adult, Quality Improvement, Surveys and Questionnaires

Citation

Permalink

https://hdl.handle.net/10161/24811

Published Version (Please cite this version)

10.1370/afm.2418

Publication Info

Jha, Manish K, Bruce D Grannemann, Joseph M Trombello, E Will Clark, Sara Levinson Eidelman, Tiffany Lawson, Tracy L Greer, A John Rush, et al. (2019). A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project. Annals of family medicine, 17(4). pp. 326–335. 10.1370/afm.2418 Retrieved from https://hdl.handle.net/10161/24811.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Collections

Scholarly Articles
Full item page

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.