Pragmatic Clinical Trial of Population Health, Portal-Based Depression Screening: the PORTAL-Depression Study

Franco, Melissa; Staab, Erin M.; Zhu, Mengqi; Knitter, Alexandra C.; Wan, Wen; Gibbons, Robert D.; Vinci, Lisa M.; Shah, Syed G.; Yohanna, Daniel; Beckman, Nancy; Laiteerapong, Neda

doi:10.1007/s11606-022-07779-9

Cited by 11 publications

(4 citation statements)

References 40 publications

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“…This final screening rate is similar to 57% achieved for a smaller sample (45 157 visits) with a medical assistant screening protocol versus 18% when physicians screened ( P < .0001) (Gorman et al, 2021). It is higher than rates found with medical assistants screening (33%) than with patient portal screening (43%) (Franco et al, 2023). Pfoh et al (2020) reached a rate of 59% after implementing a systemic depression screening program for physicians.…”

Section: Discussionmentioning

confidence: 68%

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

Miller,

Skoranski,

Prior

et al. 2023

Journal of Ambulatory Care Management

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In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, “Engage to Sustain,” for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. Shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs improves screening rates.

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Section: Discussionmentioning

confidence: 68%

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

Miller,

Skoranski,

Prior

et al. 2023

Journal of Ambulatory Care Management

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show abstract

“…Data from the nationally representative Medical Expenditure Panel Survey in 2017 showed that just 50% of primary care patients ages 35 years and older were assessed for depression ( Kato et al, 2018 ). Even in a large scale pragmatic trial of self-screening through an electronic health record portal or a clinic-based desktop computer application screening rates only reached 43% and 33%, respectively ( Franco et al, 2023 ). Screening for cognitive impairment ostensibly occurs less frequently, though few studies have examined it directly ( Bradford et al, 2009 ; Chodosh et al, 2004 ; Kotagal et al, 2015 ; Sabbagh et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Cognitive Impairment and Depression Among Middle Aged and Older Adults in Primary Care

Federman,

Becker,

Carnavali

et al. 2024

Gerontology and Geriatric Medicine

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Objectives: To determine rates of previously undetected cognitive impairment among patients with depression in primary care. Methods: Patients ages 55 and older with no documented history of dementia or mild cognitive impairment were recruited from primary care practices in New York City, NY and Chicago, IL ( n = 855). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and depression with the Patient Health Questionnaire-8. Results: The mean age was 66.8 (8.0) years, 45.3% were male, 32.7% Black, and 29.2% Latinx. Cognitive impairment increased with severity of depression: 22.9% in persons with mild depression, 27.4% in moderate depression and 41.8% in severe depression ( p = .0002). Severe depression was significantly associated with cognitive impairment in multivariable analysis (standardized β = −.11, SE = 0.33, p < .0001). Discussion: Depression was strongly associated with previously undetected cognitive impairment. Primary care clinicians should consider screening, or expand their screening, for both conditions.

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“…The health system’s EHR is provided by Epic, which uses the MyChart electronic patient portal for patient communication, medical record access, prescription management, and appointment scheduling. An electronic patient portal-based system for anxiety and depression screening for use in the University of Chicago’s adult primary care clinic was under evaluation concurrent to this study [ 40 , 41 ].…”

Section: Methodsmentioning

confidence: 99%

“…The samples included screenshots of an introduction page and a common depression screening tool, the Patient Health Questionnaire-9, as they would appear in the patient portal. Samples were gathered from the portal-based screening tool being studied concurrently in the University of Chicago adult primary care clinics [ 40 , 41 ]. The interviews allowed up to 90 min for completion and usually lasted between 30 to 60 min.…”

Section: Methodsmentioning

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

Self Cite

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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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Pragmatic Clinical Trial of Population Health, Portal-Based Depression Screening: the PORTAL-Depression Study

Cited by 11 publications

References 40 publications

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

Relationship Between Cognitive Impairment and Depression Among Middle Aged and Older Adults 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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