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. 2012 Jun;62(599):e451-7.
doi: 10.3399/bjgp12X649151.

Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring

Michael Moore  1 , Saima Ali, Beth Stuart, Gerry M Leydon, Jessica Ovens, Chris Goodall, Tony Kendrick
Affiliations

Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring

Michael Moore et al. Br J Gen Pract. 2012 Jun.

Abstract

Background: Since 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment.

Aim: To examine the association between the severity scores obtained and follow-up questionnaires to monitor depression and subsequent changes made to the treatment of it.

Design and setting: A retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within Hampshire, Wiltshire, and Southampton City primary care trusts.

Method: Records were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral.

Results: Controlling for the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95% confidence interval = 2.83 to 7.86).

Conclusion: GPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research.

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Figures

Figure 1
Figure 1
A frequency histogram illustrating the absolute change in PHQ-9 score observed between the first and second scores recorded.
Figure 2
Figure 2
A frequency histogram illustrating the recorded time between the first and second of the PHQ-9 pairs.
Figure 3
Figure 3
The odds of experiencing a management change in relation to the absolute score change between the first and second PHQ-9 scores.a
See this image and copyright information in PMC

References

    1. Singleton N, Bumpstead R, O'Brien M, et al. Psychiatric morbidity among adults living in private households, 2000. Int Rev Psychiatry. 2003;15(1–2):65–73. - PubMed
    1. National Institute for Clinical Excellence. Depression: the treatment and management of depression in adults. London: NICE; 2009. Report No: CG90.
    1. Kendrick T, King F, Albertella L, Smith PW. GP treatment decisions for patients with depression: an observational study. Br J Gen Pract. 2005;55(513):280–286. - PMC - PubMed
    1. British Medical Association. Revisions to the GMS contract, 2006/7: delivering investment in general practice. London: BMA; 2006. http://www.bma.org.uk/employmentandcontracts/independent_contractors/gen... (accessed 27 Mar 2012)
    1. NHS Employers. Changes to QOF 2009/10. Leeds: NHS Employers; 2011. http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContra... (accessed 27 Mar 2012)

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