Improving Depression Screening in Underserved Populations in a Large Urban Academic Primary Care Center: A Provider-Centered Analysis and Approach

Henry, Tracey L.; Schmidt, Stacie; Lund, Maha; Haynes, Tamara; Ford, Darby; Egwuogu, Heartley; Schmitz, Stephanie; McGregor, Brian; Toomer, Linda; Bussey‐Jones, Jada

doi:10.1177/1062860619884639

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Moreover, the use of standardised instruments such as this, which address the main depressive symptoms and not only the somatic ones (such as loss of appetite or sleep disturbance), invites the practitioner to explore more emotional, motivational aspects during the assessment and even to consider the impact on the person's daily life, thus converting the traditional biomedical assessment into a biopsychosocial one. Furthermore, the use of this or similar instruments makes it possible for the practitioner to categorise the severity of the patient's depression in a relatively simple way (Henry et al, 2020). This question is of essential importance, since the intervention adopted will depend, in every case, on the severity detected (García-Herrera Pérez-Bryan et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the use of this or similar instruments makes it possible for the practitioner to categorise the severity of the patient’s depression in a relatively simple way (Henry et al. , 2020 ). This question is of essential importance, since the intervention adopted will depend, in every case, on the severity detected (García-Herrera Pérez-Bryan et al , 2011 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A multifaceted provider-centred intervention versus usual care to improve the recognition and diagnosis of depression in primary health care: a hybrid study

Nogueras,

Cantero,

Macías

et al. 2023

Prim Health Care Res Dev

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Background: The aim of this study was to evaluate the impact of a multifaceted intervention to implement an adapted guideline for the management of depression in primary health care. Methods: A hybrid trial was carried out to determine the effect of a multicomponent provider-centred intervention to improve the detection and diagnosis of depression in primary care, as part of the guideline implementation process, and to collect information about barriers and facilitators in a real-world context. Before the multicomponent intervention, a descriptive cross-sectional study was performed to assess the population prevalence of depression in the participating health centres and to detect possible differences. Subsequently, a quasi-experimental two-phase study was carried out with a concurrent control group to assess the impact of the multicomponent intervention on the main outcomes (detection of depression, evaluation of its severity and the use of structured methods to support the diagnosis). Results: Nine-hundred seventy-four patients took part in the first phase. According to their clinical records, the prevalence of depression ranged from 7.2% to 7.9%, and there were no significant differences between the health centres scheduled to receive the intervention and those in the control group. In the experimental phase, 797 randomly selected participants received the multicomponent intervention. Adjusted multivariable analysis performed before the implementation revealed no significant differences in depression between the experimental and control groups. However, after the intervention, modest but significant differences were observed, which persisted at 1 year after the intervention. Conclusions: A multicomponent intervention for the implementation of a clinical guideline for the management of depression in primary care produced improvements in the identification of depression and in the degree of severity recorded.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A multifaceted provider-centred intervention versus usual care to improve the recognition and diagnosis of depression in primary health care: a hybrid study

Nogueras,

Cantero,

Macías

et al. 2023

Prim Health Care Res Dev

View full text Add to dashboard Cite

show abstract

“…They also discussed that not all clinicians feel equipped or comfortable with providing depression follow-up. These factors influence the accuracy of the depression screen and may indirectly impact screening rates [ 66 , 69 – 73 ]. Field notes and qualitative interviews from the rapid prototyping phase again displayed conflicting stakeholder perspectives.…”

Section: Discussionmentioning

confidence: 99%

“…We worked with a practice/physician for the pilot that already had high PHQ-2 screening rates so the practice felt assured they would not risk compromising patient care during the pilot. However, similar to other health systems, depression screening rates across Penn Medicine primary care practices are far more variable, ranging from 10 to 90% [ 69 , 72 , 75 , 76 ]. The level of engagement and motivation in the process is not surprising given our approach, which relies on innovators (i.e., those interested in and willing to engage in health system experimentation).…”

Section: Discussionmentioning

confidence: 99%

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

et al. 2021

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Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

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“…Although the need to screen for and treat anxiety and depression in PWH is great, there are many barriers to implementing systematic mental health screening in HIV care settings, including a high clinical workload, insufficient time, a lack of training in mental health, and inadequate referral resources [ 12 , 13 , 14 ]. Strategies to overcome these barriers include the use of designated ancillary staff to perform mental health assessments, electronic anxiety and depression screening during clinic visits, and the co-location of HIV and mental health services [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research

Walker,

Staab,

Ridgway

et al. 2024

IJERPH

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Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings.

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Improving Depression Screening in Underserved Populations in a Large Urban Academic Primary Care Center: A Provider-Centered Analysis and Approach

Cited by 8 publications

References 15 publications

A multifaceted provider-centred intervention versus usual care to improve the recognition and diagnosis of depression in primary health care: a hybrid study

A multifaceted provider-centred intervention versus usual care to improve the recognition and diagnosis of depression in primary health care: a hybrid study

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research

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