Implementation of Prescheduled Follow-Ups With Education Improve Poststroke Depression Screening Compliance in Routine Clinical Practice

Abstract

Objectives: To investigate the extent to which the mood of stroke patients is assessed and what kind of assessment methods are used in routine clinical practice, and whether prescheduled follow-ups can improve the detection of depression, particularly when this practice is blended with better education for health care professionals in assessing and detecting depression.

Design: Before-after trial with an 18-month follow-up and a review of medical records.

Setting: Acute care hospital, community.

Participants: Consecutive acute stroke patients (N=398) were screened. Patients lived in a health care district with a population of 132,000. The screening took place in the first half of 2010 and then again, after the implementation of the follow-up system, in the first half of 2012. After exclusion of patients too severely ill to be interviewed, there were n=105 patients in the 2010 sample and n=112 patients in the 2012 sample.

Intervention: Implementation of a follow-up path for all stroke patients.

Main outcome measures: The percentage and quality of mood assessments in the medical records; and the stroke patients' depressive symptoms and their satisfaction with their care.

Results: In the 2010 sample, 47% of the patients (n=48) had documentation of mood in their medical records. After the implementation of prescheduled follow-ups, 77% of the patients (n=86) had documented moods. The increase was highly significant (P<.001). During the early outpatient phase, the use of interviews increased from 14% (n=15) to 45% (n=50) of the patients (P<.001). The increase in the satisfaction with care did not reach statistical significance. Depressive symptoms recorded at any time were associated with depressive symptoms at 18 months (P<.001).

Conclusions: Prescheduled follow-ups for all stroke patients, including routine depression screening, can remarkably improve the compliance with depression screening and the detection of depression.

Keywords: Depression; Guideline adherence; Rehabilitation; Stroke.