Effectiveness of an intervention to improve primary care provider recognition of depression

Abstract

Context: Depression remains under-recognized and undertreated by primary care providers. While systematic screening has the potential to improve recognition, providers may overlook screening results because of barriers to accessing the information and the need to address multiple health care issues.

Objective: To determine whether limited follow-up of positive findings on depression screening improves provider recognition and initial management of depression.

Design: Before-after study.

Patients: Consecutive patients with positive findings on depression screening in a Veterans Affairs primary care clinic in Oregon during the 3 months before (n = 160) and the 3 months after (n = 97) the intervention began.

Intervention: Patients with positive findings on depression screening completed a self-administered questionnaire (Patient Health Questionnaire), which they turned in to their provider. A mental health nurse subsequently reviewed the records of patients who completed questionnaires and contacted providers when depression was not mentioned in the visit note.

Outcome measures: Documentation of depression or suicidal ideation and actions taken for depression (prescription of antidepressant medication, mental health referral, watchful waiting) at the clinic visit.

Results: The mental health nurse received questionnaires for only 39 (40%) postintervention patients. Documentation of depression symptoms (72% vs. 48%; P < 0.001) and suicidal ideation (36% vs. 14%; P < 0.001) significantly improved in the postintervention group compared with the preintervention group. Postintervention patients were also more likely to begin receiving antidepressants (23% vs. 12%; P < 0.05) and to be referred for mental health services (28% vs. 9%; P < 0.001).

Conclusion: A limited intervention can improve provider recognition and initial management of depression in a Veterans Affairs primary care setting.