Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring.
BACKGROUND
Since 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment.


OBJECTIVE
To examine the association between the severity scores obtained and follow-up  questionnaires to monitor depression and subsequent changes made to the treatment of it.


METHODS
A retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within  Hampshire, Wiltshire, and Southampton City primary care trusts.


METHODS
Records were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nine-item depression scale of the Patient Health Questionnaire (PHQ-9)  at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral.


RESULTS
Controlling for  the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95%  confidence interval = 2.83 to 7.86).


CONCLUSIONS
GPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary  care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research.
Primary and Population Science, University of Southampton, Southampton, UK. mvm198@soton.ac.uk
Michael
M
Moore
Saima
S
Ali
Beth
B
Stuart
Gerry M
GM
Leydon
Jessica
J
Ovens
Chris
C
Goodall
Tony
T
Kendrick
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005260:Female; D058006:General Practice / Q000379:methods; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
D000928:Antidepressive Agents