Assessing Depression Care In Primary Care Settings Using The Depression Quality Index
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Assessing Depression Care In Primary Care Settings Using The Depression Quality Index
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Author : Kimberly A. Hepner
language : en
Publisher: Rand Corporation
Release Date : 2005
Assessing Depression Care In Primary Care Settings Using The Depression Quality Index written by Kimberly A. Hepner and has been published by Rand Corporation this book supported file pdf, txt, epub, kindle and other format this book has been release on 2005 with Medical categories.
Clinical guidelines for depression address a wide variety of care processes in addition to the use of appropriate medication or psychotherapy treatment. Yet most studies on improving depression care evaluate only whether or not the patient has completed the appropriate treatment, potentially missing other dimensions which may affect patient outcomes, including assessment, education, and patient-centered decision-making. The ability to comprehensively measure quality of care for depression is particularly important in primary care settings. The Quality Improvement for Depression Project research team worked with a nine-member panel of clinical experts on depression from the MacArthur Foundation Initiative on Depression and Primary Care to develop and rate a comprehensive set of quality review criteria based on guidelines from the Agency for Healthcare Research and Quality. These quality review criteria form the basis for a scoring tool that generates a quality index reflecting five major phases of care: detection and assessment, acute care, continuation treatment, maintenance, and discontinuation. The index reflects both primary and mental health specialty care in relation to patient needs. The Depression Quality Index (DQI) provides a more thorough assessment of quality of depression care than previous methods, can identify specific areas for quality improvement, and could potentially increase our understanding of the link between quality depression care and depression-related outcomes.
Depression In Primary Care
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Author : C. Clifford Attkisson
language : en
Publisher:
Release Date : 1990
Depression In Primary Care written by C. Clifford Attkisson and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1990 with Medical categories.
An examination of the conceptual, methodological, statistical and clinical issues that have emerged in the investigation of the value of screening for depression in general medical clinics. The contributors recommend clinical strategies and highlight special populations issues.
Screening For Depression In Clinical Practice
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Author : Alex J. Mitchell, MRCPsych
language : en
Publisher: Oxford University Press
Release Date : 2009-12-02
Screening For Depression In Clinical Practice written by Alex J. Mitchell, MRCPsych and has been published by Oxford University Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-12-02 with Medical categories.
Mood disorders are a global health issue. National guidance for their detection and management have been published in the US and in Europe. Despite this, the rate at which depression is recognized and managed in primary and secondary care settings remains low and suggests that many clinicians are still unsure how to screen people for mood disorders. Against the backdrop of this problem, the editors of this volume have designed a book with a dynamic two-fold purpose: to provide an evidence-based overview of screening methods for mood disorders, and to synthesize the evidence into a practical guide for clinicians in a variety of settings--from cardiologists and oncologists, to primary care physicians and neurologists, among others. The volume considers all important aspects of depression screening, from the overview of specific scales, to considerations of technological approaches to screening, and to the examination of screening with neurological disorders, prenatal care, cardiovascular conditions, and diabetes and cancer care, among others. This book is sure to capture the attention of any clinician with a stake in depression screening.
Screening For Depression In Adults And Older Adults In Primary Care
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Author :
language : en
Publisher:
Release Date : 2009
Screening For Depression In Adults And Older Adults In Primary Care written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009 with categories.
BACKGROUND: Depression causes significant suffering and is commonly seen in primary care. Because primary care providers sometimes fail to identify patients as depressed, systematic screening programs in primary care may be of use in improving outcomes in depressed patients. Depression screening is predicated on the notion that identification will allow effective treatments to be delivered and that the benefits of treatment will outweigh the harms. Treatment efficacy of antidepressants and psychotherapy in general adult populations was established in a previous United States Preventive Services Task Force (USPSTF) review on depression screening, but treatment in older adults was not examined specifically. Additionally, harms of screening and treatment were not previously examined in detail. PURPOSE: This evidence report updates the evidence for the benefits and harms of screening primary care patients for depression in order to initiate or modify treatment aimed at providing relief from depression. DATA SOURCES: We developed an analytic framework and five key questions to represent the logical evidence connecting primary care screening to improved health outcomes, including remission from depression. We searched Medline, Cochrane Central Registry of Controlled Trials, and PsycINFO from 1998 to December 2007, and Cochrane Database of Systematic Reviews from 1998-October 2006 (with updates through December 2007). Separate literature search strategies were developed for harms of screening and harms of treatment. We also considered all trials included in the previous systematic review for the USPSTF and a recent Cochrane review on depression screening in primary care, contacted experts, and checked bibliographies from non-systematic reviews and other studies. We examined 4088 abstracts and 412 full-text articles. STUDY SELECTION: For all key questions, we considered evidence from studies published in English that were conducted in the United States or other similarly developed countries and met design-specific USPSTF quality standards. We included fair-to-good quality randomized clinical trials (RCTs) or controlled clinical trials (CCTs) that evaluated screening for depression in primary care settings if the screening and related interventions involved general adult primary care populations and if the control group was either unscreened or the results of the screening were not used in the care of the patient. We found no trials or studies addressing harms of screening. We included good-quality meta-analyses that examined depression treatment efficacy in older adults. We included fair-to-good quality systematic reviews, meta-analyses, and large observational studies of serious adverse events and early discontinuation due to adverse effects in adult and older adults. DATA EXTRACTION: One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked all elements. Two reviewers graded the quality of each article using USPSTF criteria. Excluded articles are listed in tables, along with the primary reason(s) for exclusion. DATA SYNTHESIS: Programs that include depression screening and staff that assist the primary care clinician by providing some direct depression care (such as care support or coordination, case management, or mental health treatment) can increase depression response and remission over usual care. However, it is unclear whether screening is a necessary component of these programs. Depression screening programs that do not provide depression care supports other than those targeted at improving the effectiveness of the primary care provider's depression treatment (without additional staff involvement) are unlikely to be effective. Antidepressants and psychotherapy are effective in treating depression in older adults, with odds of remission about twice those seen in placebo or other non-active control conditions. The most current evidence on risk of completed suicide deaths does not demonstrate a clear and uniform effect of second-generation antidepressants compared with placebo; rather, data are consistent with no effect, mild protection or some increased risk. Some meta-analyses suggest an increase in suicidal behaviors in young adults (aged 18-29 years) on antidepressants, particularly those with major depressive disorder and those taking paroxetine. In contrast, older adults have a reduced risk of suicidal behaviors during antidepressant treatment. CONCLUSIONS: Screening programs without staff-assisted depression care supports are unlikely to improve depression outcomes, although depression treatment can be effective in adults of all ages. Close monitoring of all adult patients initiating antidepressant treatment, particularly those under age 30, is important both for safety reasons and to ensure optimal treatment response.
Screening For Depression In Adults And Older Adults In Primary Care An Updated Systematic Review
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Author : U. S. Department of Health and Human Services
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-05-01
Screening For Depression In Adults And Older Adults In Primary Care An Updated Systematic Review written by U. S. Department of Health and Human Services and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-05-01 with Medical categories.
The term “depression” is not a specific term for a single diagnostic condition. Depressive disorders generally consist of major depressive disorder (MDD), dysthymia, and minor depression, but not other conditions that include depressive features, such as bipolar disorder. MDD is the most serious diagnosis, and is given to a person who meets criteria for major depressive disorder without manic or hypomanic features or a psychotic disorder. Dysthymia is similar to MDD but is generally longer-lasting and less severe. A variety of terms are used for people with depressive symptoms but whose depression does not meet criteria for MDD or dysthymia, such as subthreshold depression, subsyndromal depression, and minor depression. We conducted this review to aid the U.S. Preventive Services Task Force in updating its 2002 recommendation for adult depression screening in primary care. We focused on gaps in evidence identified by the previous review and on integrating relevant research published in the interim. We updated direct evidence that primary care depression screening programs improve health outcomes and examined evidence for the efficacy of depression treatment in older adults and evidence for the harms of screening and adverse events from antidepressant treatment in adults and older adults. Depression is a chronic disease characterized by partial remissions and recurrences in most of those who recover fully. While depression can occur in people of any age, the average age of onset is in the mid-twenties. Individuals are at risk for depression across their entire adult life span. Consistently identified high-risk groups include: women; people with other psychiatric disorders, including substance misuse; people with a family history of depression; people with chronic medical diseases; and people who are unemployed or with lower socio-economic status. While the prevalence of MDD is lower in community-dwelling older adults than in younger adults, significant depressive symptomatology is associated with common life events in older adults, including medical illness, cognitive decline, bereavement, and institutional placement in residential or inpatient settings. Although MDD is somewhat less prevalent in older adults, depression is a significant public health issue is this age group. Older adults have the highest risk of suicide of all age groups. Depression can be particularly difficult to identify in older patients, and much of the burden of depression diagnosis will fall to primary care providers. Diagnosis is complicated because medical conditions or medications can cause symptoms of depression, such as weight loss or appetite change, psychomotor retardation, loss of energy or fatigue, insomnia or hypersomnia, and difficulty concentrating. Further, the depressive symptoms of depressed mood and feelings of guilt tend to be less prominent in older depressed patients, whose primary complaints tend to be somatic. Depression in older adults is further complicated by the high levels of co-morbidity with medical conditions, including cancer, cardiovascular disease, neurological disorders, metabolic disturbances, arthritis, and sensory loss. Key Questions presented in this report include: KQ1: Is there direct evidence that screening for depression among adults and older adults in primary care reduces morbidity and/or mortality? KQ1a: What is the impact of clinician feedback of screening test results on depression response and remission in screen-detected depressed patients receiving primary care? KQ2: What are the harms of screening for depressive disorders in adults and older adults? KQ 3: Is antidepressant and/or psychotherapy treatment of older depressed adults effective in improving health outcomes? KQ4: What are the adverse effects of antidepressant treatment for depression in adults and older adults?
Screening And Management Of Depression In Primary Care
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Author : Darren Himeles
language : en
Publisher:
Release Date : 2015
Screening And Management Of Depression In Primary Care written by Darren Himeles and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with categories.
Background : Depression is a common psychiatric illness that is a major source of disability, morbidity, and mortality. When diagnosed, depression is highly treatable with many effective interventions. The Patient Health Questionnaire-9 (PHQ-9) is an effective tool for screening and monitoring depression. Many cases of depression are diagnosed and treated in the primary care setting. The United States Preventive Services Task Force (USPSTF) says that universal screening for depression can be helpful for clinicians to identify cases of undiagnosed depression. Others, like James Coyne Ph.D., question the utility of universal screening in primary care. Methods : Data on a universal depression screening program and the actions that followed when a patient screened positive were assessed to determine the effectiveness of such a system. as well as to understand if those with chronic illness more often screened positive and when screened positive were actions taken different than for patients who screened positive and did not have such chronic illness. Results : A total of 16,519 patients completed a PHQ-2 screening for depression and 1,095 patients were then given a PHQ-9. The proportion of patients with diabetes, obesity, and cancer who screened positive were higher than patients without any of these conditions. Referral rates to collaborative care were also higher among patients with those chronic illnesses. Conclusions : Universal depression screening can be done efficiently in a family medicine setting to identify cases of depression and provide appropriate interventions to those patients. Screening for depression may be better focused on patients with chronic illness.
Depression In Parents Parenting And Children
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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2009-10-28
Depression In Parents Parenting And Children written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-10-28 with Medical categories.
Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. Depression in Parents, Parenting, and Children highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration. A major challenge to the effective management of parental depression is developing a treatment and prevention strategy that can be introduced within a two-generation framework, conducive for parents and their children. Thus far, both the federal and state response to the problem has been fragmented, poorly funded, and lacking proper oversight. This study examines options for widespread implementation of best practices as well as strategies that can be effective in diverse service settings for diverse populations of children and their families. The delivery of adequate screening and successful detection and treatment of a depressive illness and prevention of its effects on parenting and the health of children is a formidable challenge to modern health care systems. This study offers seven solid recommendations designed to increase awareness about and remove barriers to care for both the depressed adult and prevention of effects in the child. The report will be of particular interest to federal health officers, mental and behavioral health providers in diverse parts of health care delivery systems, health policy staff, state legislators, and the general public.
Screening For Depression
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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-07-01
Screening For Depression written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-07-01 with Medical categories.
Depressive disorders are common, chronic, and costly. Lifetime prevalence levels from community-based surveys range from 4.9% to 17.1%. In primary care settings, the prevalence of major depression is 6% to 8%. Longitudinal studies suggest that about 80% of individuals experiencing a major depressive episode will have at least 1 more episode during their lifetime, with the rate of recurrence even higher if minor or sub-threshold episodes are included. Approximately 12% of patients who experience depression will have a chronic, unremitting course. The substantial public health and economic significance of this chronic illness is reflected by the considerable utilization of health care visits and tremendous monetary costs: $43 billion (1990 dollars) annually, with $17 billion of that resulting from lost work days. The burden of suffering from depression is substantial. Suicide, the most severe of depressive sequelae, has a rate of approximately 3.5% among all cases with major depression, a risk that increases to approximately 15% in people who have required psychiatric hospitalization. The specific risk for suicide associated with depressive disorders is elevated 12- to 20-fold compared to the general population. The World Health Organization (WHO) identified major depression as the fourth leading cause of worldwide disease burden in 1990, causing more disability than either ischemic heart disease or cerebrovascular disease. Its associated morbidity is expected to increase; unipolar depressive illness is projected to be the second leading cause of disability worldwide in 2020. Furthermore, depression appears to contribute to increased morbidity and mortality from other medical disorders, such as cardiovascular disease. Both the chronicity and recurrence of depressive illness play a large role in depression's heavy disease burden. The more severe a depression becomes and the longer it lasts, the greater the likelihood that the depression will become chronic. Consequently, early effective identification and management of depressive illness will not only decrease the substantial morbidity associated with the current episode but may also decrease the likelihood that the illness will become chronic, with its additional associated morbidity. Key questions addressed include: 1. What is the accuracy of screening instruments for depression in primary care populations? 2. Is treatment of depression in primary care patients (with pharmacologic therapy, psychotherapy, combinations of the 2, or educational interventions) effective in improving outcomes? 3. Is screening more effective than usual care in identifying patients with depression, facilitating treatment of patients with depression, and improving outcomes?
Screening For Depression In Adult Primary Care Setting
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Author : Modupe Deborah Togun
language : en
Publisher:
Release Date : 2020
Screening For Depression In Adult Primary Care Setting written by Modupe Deborah Togun and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020 with categories.
" Depression is common in the adult population. The purpose of this evidence-based practice change project was to increase the knowledge of medical healthcare providers regarding the need of screening for depression in their adult patients. The clinical problem involved a lack of patient identification with depression, the need for a depression screening protocol as a quality measure, and the need to link untreated individuals with depression to mental health services. A two-part design was utilized for this evidence-based project. Nine healthcare providers and medical staff were recruited from a family medical practice with the majority female, non-Hispanic, and between 26 - 49 years of age. The First 1-hour educational intervention presented to the participants addressed the signs and symptoms of depression, triage role-plays, and the screening protocol. Depression knowledge and confidence were measured by a self-created 10-item questionnaire. Six out of the ten items were related to knowledge and confidence. The six items used a 5-point Likert scale. These questionnaires were given at pre and two-week post-educational sessions. Second, the healthcare providers participated in an eight-week EBP change process that involved depression screening and treatment referrals as indicated. The results yielded an overall increase in staff knowledge and confidence based on the groups' mean comparison at two points. Participants identified they would change their practice. These findings support the implementation of an educational intervention regarding depression screening in adults that can ultimately improve patient outcomes. Keywords: depression screening, adult depression screening, and primary care, provider's knowledge and depression screening, depression education and providers, and barriers to depression screening " -- Abstract
Depression In Primary Care
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Author : Simon M. Gilbody
language : en
Publisher:
Release Date : 2011
Depression In Primary Care written by Simon M. Gilbody and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with Depression, Mental categories.
"Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike. - Combines clear evidence summaries with a simple and practical guide about how to implement quality improvement programmes in practice - Prepared by international experts and of interest and relevance in all countries and healthcare settings - Addresses a major healthcare priority identified by the World Health Organization, US Agency for Healthcare Research and UK National Institute for Clinical Excellence"--Provided by publisher.