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Improving Recognition of Depression in Primary Care: A Study of Evidence-Based Quality Improvement

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Abstract:

Background: Depression's high prevalence and large amount of potentially modifiable morbidity make it an excellent candidate for quality improvement (QI) techniques. Yet there is little evidence on how to promote adherence to evidence-based guidelines. A locally run research and QI project that was part of a larger National Institute of Mental Health–funded study to implement depression guidelines was implemented by a primary care team at a Department of Veterans Affairs (VA) ambulatory care center in 1997 and 1998.

Development of the QI Intervention: The plan to improve screening and recognition entailed systematically screening all patients attending the primary care clinic; sending computer reminders to clerical staff, nursing assistants, and primary care providers; and auditing team performance with monthly feedback.

Results: Once the intervention was in place, nearly all patients were screened. The primary care provider documented the assessment of whether a patient was depressed for nearly all patients who screened positive. Few resources were needed to maintain the project once it was implemented.

Discussion: An evidence-based QI intervention led to profound and lasting changes in primary care providers' recognition of depression or depressive symptoms. The QI implementation continued for one year after the intervention's end, but a new VA computerized medical record system uses similar computer-generated reminders.

Document Type: Research Article

Publication date: 2004-02-01

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  • The Joint Commission Journal on Quality and Patient Safety will be published by Elsevier beginning in 2017! For readers who receive access to the journal through their institutions, the journal can now be found on ScienceDirect (http://www.sciencedirect.com/science/journal/15537250). For librarians looking to subscribe to the journal for their institutions please contact your Elsevier Account Manager or visit www.myelsevier.com for more information. All other readers, please visit http://www.jointcommissionjournal.com/ to subscribe to the journal or to claim your access for an existing subscription.
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