scholarly journals Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre

2020 ◽  
Vol 9 (4) ◽  
pp. e000751
Author(s):  
Mohamed Mansour ◽  
Dharshana Krishnaprasadh ◽  
Janice Lichtenberger ◽  
Jonathan Teitelbaum
Keyword(s):  
Quality Improvement ◽  
Adolescent Depression ◽  
Quality Improvement Project ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Screening Rate ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Patient Health

BackgroundDepression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression.MethodsIn this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age.ResultsIt was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period.ConclusionStandardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.

Initiation of Standardized Depression Screening in College Health: A Quality Improvement Project

2018 ◽  
Vol 11 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Kristen Slabaugh ◽  
Shannon Harris ◽  
Samuel Wilcock
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Quality Improvement Project ◽  
Health Clinic ◽  
College Health ◽  
Mentoring Program ◽  
Health Questionnaire ◽  
Improvement Project ◽  
Patient Health ◽  
Standardized Screening

Background: Depression is a leading health concern in college health. An on-campus health clinic was identified as conducting complaint-based screening. U.S. Preventative Services Task Force recommends standardized screening in all primary care settings. Objective: To implement a quality improvement project for standardized screening and referral of depressive symptoms and identify factors related to mentoring program interest in a college health clinic. Methods: Demographic survey and Patient Health Questionnaire-2 (PHQ-2) were distributed to students who met inclusion criteria. Positive screens received further intervention with Patient Health Questionnaire-9 (PHQ-9) and immediate evaluation, encouragement of follow-up, or educational handout. Results: Of students receiving primary care services at a college health center, 221 completed demographic surveys, 165 completed the PHQ-2, and eight students received interventions for positive screens. Furthermore, 74.6% of students expressed interest in a mentoring program. Conclusions: The project demonstrates ease of standardized screening in the college health setting without excessive burden to staff or budget. This is a critical preventative care measure for improving early detection and management of depression at college health centers. Implications for Nursing: Initiation of standardized screening on college campuses is a worthwhile investment and should be implemented by registered nurses (RNs) and advanced practice nurses. Support program initiation should be considered to help students with unmanaged symptoms.

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

scholarly journals The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Saman Maroufizadeh ◽  
Reza Omani-Samani ◽  
Amir Almasi-Hashiani ◽  
Payam Amini ◽  
Mahdi Sepidarkish
Keyword(s):  
Depressive Symptoms ◽  
Internal Consistency ◽  
Convergent Validity ◽  
Univariate Analysis ◽  
Reliability And Validity ◽  
Well Being ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Patient Health

Abstract Background Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. Methods In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. Results The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. Conclusion Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

scholarly journals Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder

2015 ◽  
Vol 2 (1) ◽  
pp. e8 ◽  
Author(s):  
John Torous ◽  
Patrick Staples ◽  
Meghan Shanahan ◽  
Charlie Lin ◽  
Pamela Peck ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Low Cost ◽  
Time Of Day ◽  
Patient Health Questionnaire ◽  
Therapeutic Monitoring ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Major Depressive ◽  
Patient Health

Background Accurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care. Objective To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores. Methods A total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9. Results Overall adherence was 77.78% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9. Conclusions Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9.

Preventing complications: Hepatitis B screening in cancer patients undergoing systemic therapy.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 237-237
Author(s):  
Rebecca M. Prince ◽  
Monika K. Krzyzanowska ◽  
Victoria Glinsky ◽  
David K Wong ◽  
Alyssa Macedo
Keyword(s):  
Quality Improvement ◽  
Systemic Therapy ◽  
Quality Improvement Project ◽  
Screening Tests ◽  
Hbv Reactivation ◽  
Screening Rate ◽  
Improvement Project ◽  
Safety Event ◽  
Chronic Hbv ◽  
Hbv Screening

237 Background: Chemotherapy is a risk factor for HBV reactivation in pts with cancer and chronic HBV. Anti-viral prophylaxis can prevent reactivation but requires identification of infected pts. Many guidelines recommend universal HBV screening prior to cytotoxic/immunosuppressive-therapy, but lack of screening is common globally. A serious safety event and high prevalence of pts from HBV endemic regions receiving treatment at our institution led to a quality improvement project to increase HBV screening prior to chemotherapy. We aimed to increase HBV screening in pts starting systemic therapy at Princess Margaret by 100% by February 28, 2019. Methods: Starting April 2017, an interrupted time series study was undertaken. Baseline HBV screening rate was 43%. Diagnostics including interviews, process mapping and root cause analysis were performed. Interventions to address identified root causes were implemented including specifying required HBV tests, tips for ordering HBV tests, provision of electronic Hepatology referral form, a safety alert email, grand rounds presentation of serious safety event, including HBV screening rate in departmental monthly quality emails and Divisional meetings and adding positive HBV results to the laboratory alerting system. The main outcome measure was the proportion of pts starting systemic therapy screened for HBV. Process measures included correct test ordering, number of Hepatology referrals was a balancing measure. Results were analysed with statistical process control charts. Results: From April 2017-Feb 2019, 5604 pts commenced systemic therapy. Interventions were modified iteratively as the project progressed. HBV screening rate improved from 43 to 79% (84% improvement). Incidence of chronic HBV was routinely above the Canadian average ( > 2%). The percent of correctly ordered screening tests fell from 48 to 33% (31% worsening), while the volume of Hepatology referrals remained manageable (1.5 pts/week). Conclusions: Our Quality Improvement project led to a significant improvement in HBV screening prior to systemic therapy. Further interventions are planned to achieve our target improvement of 100%.

The factor structure of major depression symptoms: A test of four competing models using the Patient Health Questionnaire-9

2012 ◽  
Vol 199 (3) ◽  
pp. 169-173 ◽  
Author(s):  
Jon D. Elhai ◽  
Ateka A. Contractor ◽  
Marijo Tamburrino ◽  
Thomas H. Fine ◽  
Marta R. Prescott ◽  
...  
Keyword(s):  
Major Depression ◽  
Factor Structure ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Patient Health ◽  
Competing Models

Perceived Barriers and Motivators for Physical Activity in Women With Perinatal Depression

2021 ◽  
pp. 1-10
Author(s):  
Sylvia E. Badon ◽  
Esti Iturralde ◽  
Linda Nkemere ◽  
Nerissa Nance ◽  
Lyndsay A. Avalos
Keyword(s):  
Physical Activity ◽  
Focus Groups ◽  
Perinatal Depression ◽  
Screening Program ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Depression Symptom ◽  
Health Questionnaire ◽  
Patient Health ◽  
Barriers And Motivators

Background: Physical activity (PA) can help reduce depression symptom severity in women with perinatal depression. However, PA is low, and barriers and motivators for PA among women with perinatal depression are not well understood. Methods: An ethnically diverse sample of women with perinatal depression was identified using a universal perinatal depression screening program. The authors conducted 8 focus groups (4 in pregnant women [n = 15] and 4 in postpartum women [n = 20]). Depression symptoms were measured using the Patient Health Questionnaire-8 at recruitment. Focus groups were analyzed using an inductive approach. Results: Pregnant participants were 27 weeks gestation, and postpartum participants were 11.5 months postpartum, on average. Depression symptoms were moderately severe (mean Patient Health Questionnaire-8 score: 16). Women identified practical barriers and motivators for PA common to perinatal women (physical health, parental responsibilities, PA tracking tools, and environmental factors) and described emotional and social factors influencing PA. Motivators included using PA to improve mood, relieve stress, boost self-image, and spend time with others. Bad mood, fear of social judgment, and feeling discouraged made it difficult to be active. Conclusion: PA interventions in women with perinatal depression should include components addressing emotional and social barriers to PA in addition to addressing additional common practical barriers to PA.

Maternal Functioning and Depression Scores Improve Significantly With Participation in Visiting Moms® Program

2019 ◽  
Vol 27 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Jennifer L. Barkin ◽  
Laura Beals ◽  
Christy C. Bridges ◽  
Amara Ezeamama ◽  
Marta Serati ◽  
...  
Keyword(s):  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Adult Women ◽  
Health Questionnaire ◽  
Paired Data ◽  
New Mothers ◽  
Entire Family ◽  
Maternal Functioning ◽  
Patient Health ◽  
Additional Support

BACKGROUND: Postpartum depression is the most common complication of childbearing can affect the entire family unit. Health professionals must strive to identify and develop effective, feasible solutions for women during this critical period. AIMS: To determine whether postpartum maternal functioning (as measured by the Barkin Index of Maternal Functioning) and depression symptoms (as measured by the Patient Health Questionnaire-9) were improved after participation in the Visiting Moms program. METHOD: Paired data were collected from women at program intake and after completion of the Visiting Moms program. Visiting Moms provides services through eastern and central Massachusetts and was designed to support new mothers throughout the infant’s first year of life. The study population was composed of adult women living in the Jewish Family and Children’s Services geographic catchment area, who enrolled in Visiting Moms between January 1, 2013, and December 31, 2015. Descriptive statistics were calculated for all 402 women enrolled in this timeframe. Utilizing a pretest/posttest design, paired t tests were performed for the Barkin Index of Maternal Functioning ( n = 149) and for the Patient Health Questionnaire-9 ( n = 156), where women had complete scores at both intake and completion, to determine the program’s potential impact on depressive symptoms and functional status. RESULTS: Functioning and depression scores were significantly improved after participation in the program. CONCLUSIONS: Visiting moms, and similar programs, aimed at delivery of enhanced social support, may be effective in promoting mental and emotional wellness among new mothers who are require additional support in the postpartum period.

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