Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression.
OBJECTIVE
The purpose of this study was to implement a continuous quality improvement project aimed at improving primary care provider recognition of depression.


METHODS
A randomized, blinded, pre- and post-test design was implemented with 92 adults attending an academic internal medicine clinic. Subjects were assigned to an intervention where healthcare technicians (HCT) trained in the fundamentals of diabetes education delivered brief probing questions about self-care behavior and tailored talking points to encourage patients to talk to their primary care physician about their emotional health. The control group received a sham intervention that included only information on standards of diabetes care. Measures included both a paper-and-pencil screening of depression and the Primary Healthcare Questionnaire-8 (PHQ-8). Outcomes were evaluated for antidepressant and/or counseling treatment modalities once the possibility of depression was identified.


RESULTS
Both the control and intervention groups improved from pre-test to 3-month post-test scores on the PHQ-8 in clinically significant ways, but continued to have moderate to severe depression symptoms. There was a significant likelihood of receiving antidepressant therapy and/or counseling in those who scored high on the PHQ-8.


CONCLUSIONS
HCT can be trained to talk to patients about emotional health issues during routine primary care visits. Depression screening measures can be administered as part of the triage routine at the start of a primary care visit, along with tasks such as vital signs. Answering a screening measure can help create awareness of symptoms and feelings that can prompt discussion during the patient-provider encounter that can result in the diagnosis and treatment of depression.
Department of Medicine Division of Endocrinology, Diabetes, & Metabolism and the Division of Academic Medicine, UMDNJ-New Jersey Medical School, Newark, USA.
Melissa
M
Scollan-Koliopoulos
Department of Medicine Division of Endocrinology, Diabetes, & Metabolism and the Division of Academic Medicine, UMDNJ-New Jersey Medical School, Newark, USA.
Iris
I
Herrera
Department of Medicine Division of Endocrinology, UMDNJ-the University Hospital, Newark, USA.
Karen
K
Romano
Department of Medicine Division of Endocrinology, Diabetes, & Metabolism and the Division of Academic Medicine, UMDNJ-New Jersey Medical School, Newark, USA ; Department of Health Education, William Paterson University, Wayne, USA.
Carrie
C
Gregory
Department of Medicine Division of Endocrinology, Diabetes, & Metabolism and the Division of Academic Medicine, UMDNJ-New Jersey Medical School, Newark, USA ; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Jersey, USA.
Kenneth
K
Rapp
Department of Medicine Division of Endocrinology, Diabetes, & Metabolism and the Division of Academic Medicine, UMDNJ-New Jersey Medical School, Newark, USA.
David
D
Bleich
Depression; diabetes; healthcare technicians; primary care