title: Measuring adherence to depression treatment guidelines in a VA primary care clinic.
abstract: The primary objectives of this pilot study were to develop a measure of adherence for depression practice guidelines and to assess the degree to which providers and patients adhere to guidelines in a VA primary care setting. The Depression Guideline Measure (DGM) is based on three national guidelines. The DGM was used to review medical records of 111 patients with Patient Health Questionnaire (PHQ) scores >or=10. Interrater reliability for 15 of 19 DGM checklist items was excellent (kappa > 0.75). There was a broad range of adherence to guideline criteria: only 13.5% of patients were contacted for follow-up within 2 weeks, while 100% of providers documented follow-up plans. Forty percent of patients saw mental health providers, and 63% were prescribed antidepressants. A secondary objective of the study was to explore the relationship between guideline adherence and changes in PHQ scores. Among 51 patients who completed follow-up PHQs, no associations were detected. The results suggest that the DGM shows promise as a reliable measure of guideline adherence and that guideline criteria are frequently not met in busy primary care clinics. More research is needed to determine the validity of the DGM and the impact of guideline adherence on depression outcomes.
authors.affiliation: Behavior Health and Clinical Neurosciences Division, Portland VA Medical, Center, Portland, OR, USA.dobschas@ohsu.edu
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.forename: Martha S
authors.initials: MS
authors.lastname: Gerrity
authors.forename: Kathryn
authors.initials: K
authors.lastname: Corson
authors.forename: Alison
authors.initials: A
authors.lastname: Bahr
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Cuilwik
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs