title: Quality indicators for depression care in HIV patients.
abstract: HIV patients are at increased risk for depression. However, a comprehensive set of quality of care indicators for depression in the context of HIV does not exist. We report the results of a recent expert panel convened to develop a comprehensive set of HIV depression quality indicators. We systematically reviewed the depression and HIV depression literature to provide the evidence for the quality indicators. The HIV depression quality indicators were divided into six chapters: general, bereavement, substance abuse, viral hepatitis, cognitive impairment and drug interactions. A modified Delphi expert panel method was used to evaluate the validity and feasibility of the candidate quality indicators. The expert panel included HIV physicians, psychiatrists and a pharmacist, all with experience with HIV depression. The in-person eleven-member panel rated 80 candidate HIV-depression quality indicators. Indicators were evaluated using main and sensitivity analysis criteria for validity and feasibility. Seventy-four percent (59/80) of the quality indicators met a priori main analysis criteria for validity and feasibility and 61% met sensitivity analysis criteria. Approved indicators that are more specific to HIV depression include: depression screening frequency; depression screening and treatment in the context of hepatitis C; optimizing depression and HIV treatment in the context of cognitive impairment; and starting antidepressants at lower doses but advancing to doses typical for the general population. Most adverse medication interaction indicators did not meet main analysis validity criteria. The quality indicators identified in this study provide a useful tool for measuring and informing the quality of HIV-depression care.
authors.affiliation: CAVHS, Center for Mental Health Outcomes Research, North Little Rock, USA. jmpyne@uams.edu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Katherine
authors.initials: K
authors.lastname: Lincourt
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Candice
authors.initials: C
authors.lastname: Bowman
authors.forename: Hamp
authors.initials: H
authors.lastname: Atkinson
authors.forename: Allen
authors.initials: A
authors.lastname: Gifford
mesh_terms: D003697:Delphi Technique; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006117:Grief; D015658:HIV Infections / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D008297:Male; D011480:Protease Inhibitors / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D011480:Protease Inhibitors