Targeted versus tailored multimedia patient engagement to enhance depression recognition and treatment in primary care: randomized controlled trial protocol for the AMEP2 study

Tancredi, Daniel J.; Jerant, Anthony F; Franks, Peter; Nettiksimmons, Jasmine; Cipri, Camille; Gottfeld, Dustin; Huerta, Julia; Feldman, Mitchell D.; Jackson-Triche, Maja; Kelly-Reif, Steven; Hudnut, Andrew; Olson, Sarah J.; Shelton, Janie F.; Kravitz, Richard L.

doi:10.1186/1472-6963-13-141

Cited by 20 publications

(22 citation statements)

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“…21 The study design has been previously described in detail. 21,22 The trial included a stratified sample of depressed and non-depressed patients who were randomized to one of two patient-level depression engagement interventions or a control intervention, all of which were delivered in primary care offices immediately prior to previously scheduled follow-up visits for various reasons (i.e., not solely for depression care). There were no physician-level interventions.…”

Section: Methodsmentioning

confidence: 99%

Impact of Patient Requests on Provider-Perceived Visit Difficulty in Primary Care

et al. 2014

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BACKGROUND: "Difficult visits" are common in primary care and may contribute to primary care provider (PCP) career dissatisfaction and burnout. Patient requests occur in approximately half of primary care visits and may be a source of clinician-patient miscommunication or conflict, contributing to perceived visit difficulty. OBJECTIVE: We aimed to determine associations between types of patient requests and PCP-perceived visit difficulty. DESIGN: This was an observational study, nested in a multicenter randomized trial of depression engagement interventions. SUBJECTS: We included 824 patient visits within 135 PCP practices in Northern California occurring from June 2010 to March 2012. MAIN MEASURES: PCP-perceived visit difficulty was quantified using a three-item scale (relative visit difficulty, amount of effort required, and amount of time required; Cronbach's α=0.81). Using linear regression, the difficulty scale (score range 0-2 from least to most difficult) was modeled as a function of: patient requests for diagnostics tests, pain medications, and specialist referrals; PCP perception of likely depression or likely substance abuse; patient sociodemographics, comorbidity, depression; PCP characteristics and practice setting. RESULTS: Patients requested diagnostic tests, pain medications, and specialist referrals in 37.2, 20.0 and 30.0 % of visits, respectively. After adjustment for patient medical and psychiatric complexity, perceived difficulty was significantly higher when patients requested diagnostic tests CONCLUSIONS: PCP-perceived visit difficulty is associated with patient requests for diagnostic tests, but not requests for pain medications or specialist referrals. In this era of "choosing wisely," PCPs may be challenged to respond to diagnostic test requests in an evidence-based manner, while maintaining the provider-patient relationship and PCP career satisfaction.

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Section: Methodsmentioning

confidence: 99%

Impact of Patient Requests on Provider-Perceived Visit Difficulty in Primary Care

et al. 2014

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“…Participating providers were not informed that depression was the focus of the study. 22,28 Nonetheless, some may have been prompted to consider and treat depression during participation (eg, after encountering patients activated by the interventions to discuss depression), potentially increasing their tendency to use brief measures and/or prescribe antidepressants. Also, we lacked information regarding the specifics of provider use of brief symptom measures, such as the indication (eg, case finding vs screening) and interpretation (eg, cut points used to define clinical depression).…”

Section: Discussionmentioning

confidence: 99%

“…The RCT procedures, interventions, and outcomes have been reported elsewhere and included patients across the spectrum of PHQ-9 scores. 22,28 In previous PHQ-9 validation work, among individuals with a score of Ͻ10, only 5 (1.0%) had major depression based on expert diagnostic interview. 4,6 Thus, the sample for these anal- yses included only RCT participants with a PHQ-9 score Ͻ10 and complete visit record review data.…”

Section: Methodsmentioning

confidence: 99%

“…Record abstractors also ascertained evidence of provider recommendation and/or prescription of an antidepressant during the study visit. 28 Coding options were antidepressant recommended (but not prescribed), antidepressant prescribed, or neither. Analyses Stata version 13.0 (Stata Corp., College Station, TX) was used.…”

Section: Methodsmentioning

confidence: 99%

“…The abstractors also reviewed visit notes for evidence (yes vs no) of practice (eg, provider or office staff) administration of a brief depression symptom measure (ie, not the study-administered PHQ-9, which was undisclosed to study providers). 28 If relevant, abstractors documented which specific measure was administered. Record abstractors also ascertained evidence of provider recommendation and/or prescription of an antidepressant during the study visit.…”

Section: Methodsmentioning

confidence: 99%

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Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures

Jerant

Kravitz

Garcia

et al. 2014

The Journal of the American Board of Family Medicine

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Background: Use of brief depression symptom measures for identifying or screening cases may help to address depression undertreatment, but whether it also leads to diagnosis and treatment of patients with few or no symptoms-a group unlikely to have major depression or benefit from antidepressants-is unknown. We examined the associations of use of a brief depression symptom measure with depression diagnosis and antidepressant recommendation and prescription among patients with few or no depression symptoms.Methods: We conducted exploratory observational analyses of data from a randomized trial of depression engagement interventions conducted in primary care offices in California. Analyses focused on participants scoring <10 on a study-administered 9-item Patient Health Questionnaire (PHQ-9) (completed immediately before an office visit and not disclosed to the provider) with complete chart review data (n ‫؍‬ 595). We reviewed visit notes for evidence of practice administration of a brief symptom measure (independent of the trial) and whether the provider (1) diagnosed depression or (2) recommended and/or prescribed an antidepressant.Results: Among the 545 patients without a practice-administered measure, 57 (10.5%) had a visit diagnosis of depression; 9 (1.6%) were recommended and another 21 (3.8%) prescribed an antidepressant. Among the 50 patients (8.4% of total sample) with a practice-administered measure, 10 (20%) had a visit diagnosis of depression; 6 (12%) were recommended and another 6 (12%) prescribed an antidepressant. Adjusting for nesting within providers, trial intervention, stratification variables, and sample weighting, use of a brief symptom measure was associated with depression diagnosis (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.2) and antidepressant recommendation and/or prescription (adjusted odds ratio, 3.80; 95% confidence interval, 1.0 -13.9). Analyses using progressively lower PHQ-9 thresholds (<9 to <5) and examining antidepressant prescription alone yielded consistent findings. Analyses by practice-administered measure (PHQ-9 vs PHQ-2) indicated the study findings were largely associated with PHQ-9 use.Conclusions: These exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure. (J Am Board Fam Med 2014;27:611-620.)

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Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care

Kravitz

Franks

Feldman

et al. 2013

JAMA

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to address depression symptoms and care with clinicians could improve outcomes but may also result in unnecessary treatment.OBJECTIVE To determine whether a depression engagement video (DEV) or a tailored interactive multimedia computer program (IMCP) improves initial depression care compared with a control without increasing unnecessary antidepressant prescribing. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial comparing DEV, IMCP, and control among 925 adult patients treated by 135 primary care clinicians (603 patients with depression and 322 patients without depression, defined by Patient Health Questionnaire-9 [PHQ-9] score) conducted from June 2010 through March 2012 at 7 primary care clinical sites in California. INTERVENTIONS DEV targeted to sex and income, an IMCP tailored to individual patient characteristics, and a sleep hygiene video (control).MAIN OUTCOMES AND MEASURES Among depressed patients, superiority assessment of the composite measure of patient-reported antidepressant drug recommendation, mental health referral, or both (primary outcome); depression at 12-week follow-up, measured by the PHQ-8 (secondary outcome). Among nondepressed patients, noninferiority assessment of clinician-and patient-reported antidepressant drug recommendation (primary outcomes) with a noninferiority margin of 3.5%. Analyses were cluster adjusted. RESULTSOf the 925 eligible patients, 867 were included in the primary analysis (depressed, 559; nondepressed, 308). Among depressed patients, rates of achieving the primary outcome were 17.5% for DEV, 26% for IMCP, and 16.3% for control (DEV vs control, 1.

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Targeted versus tailored multimedia patient engagement to enhance depression recognition and treatment in primary care: randomized controlled trial protocol for the AMEP2 study

Cited by 20 publications

References 70 publications

Impact of Patient Requests on Provider-Perceived Visit Difficulty in Primary Care

Impact of Patient Requests on Provider-Perceived Visit Difficulty in Primary Care

Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures

Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care

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