Evaluation of the role of training in the implementation of a depression screening and treatment protocol in 2 academic outpatient internal medicine clinics utilizing the electronic medical record.
Systematic approaches to depression identification and management are effective though not consistently implemented. The research team implemented a depression protocol, preceded by training, in 2 faculty-resident practices. Medical assistants used the Patient Health Questionnaire (PHQ)-2 for initial screening; providers performed the PHQ-9. These were documented in the electronic medical record. Logistic regression was performed to assess the association of provider type, clinic site, and training attendance with documentation of PHQ-9 after positive PHQ-2s, and with repeat PHQ-9s after positive PHQ-9s. In logistic regression analysis, training attendance was positively associated with documentation of PHQ-9 after a positive PHQ-2 (odds ratio [OR] = 2.4 [confidence interval (CI) = 1.3-4.3]) and repeated documentation of a PHQ-9 after a positive PHQ-9 (OR = 2.5 [CI = 1.1-5.3]). This study describes the successful implementation of a stepped-care approach to depression care. The positive association of training with compliance with protocol procedures indicates the importance of training in the implementation of practice change.
University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO danielle.loeb@ucdenver.edu.
Danielle
D
Loeb
University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO.
Amber
A
Sieja
University of Colorado School of Medicine, Department of Internal Medicine, Aurora, CO.
Janet
J
Corral
University of Colorado School of Medicine, Division of General Internal Medicine, Department of Internal Medicine, Aurora, CO.
Nichole G
NG
Zehnder
University of Colorado School of Medicine, Dean's Office, Aurora, CO.
Gretchen
G
Guiton
University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO.
Donald E
DE
Nease
D000554:Ambulatory Care Facilities; D020000:Decision Support Systems, Clinical; D003863:Depression / Q000175:diagnosis*; D057286:Electronic Health Records; D006801:Humans; D007388:Internal Medicine; D016015:Logistic Models; D058996:Quality Improvement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
PHQ-2; PHQ-9; care delivery workflow; decision support; depression; patient-reported outcomes; primary care; quality improvement