scholarly journals Using web-based technology to improve depression screening in primary care settings

2021 ◽  
Vol 10 (1) ◽  
pp. e001028
Author(s):  
Jessica Jeffrey ◽  
Minh-Chau T Do ◽  
Nastassia Hajal ◽  
Yu-Hsiang Lin ◽  
Rachel Linonis ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Assessment Tool ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Systematic Screening ◽  
Web Based ◽  
Systems Planning ◽  
Primary Care Settings ◽  
Patient Health

BackgroundGiven the high rates at which patients present with behavioural health (BH) concerns in primary care (PC), this setting has become the de facto mental health system. As a result, screening for depression and other BH conditions in PC has become a critical target for improving patient outcomes. However, integration of screening into busy PC workflows can be challenging due to barriers such as limited time and resources.MethodologyA digital, cloud-based BH assessment tool, which included electronic health record enhancements, was developed and implemented in two urban PC practices as a prelude to a planned larger-scale implementation. The implementation strategies included a reorganisation of workflows within the PC setting, comprehensive training for staff and PC physicians, and institution of an incentive programme for PC clinic managers. To examine whether the introduction of the cloud-based BH assessment tool and associated implementation strategies was associated with increased screening rates, we compared rates of screening from January through June 2017 to rates of screening from January through June 2018 (subsequent to implementation). We also examined BH symptomatology reported by patients in PC.ResultsFollowing the implementation process, rate of BH screening with Patient Health Questionnaire-2 (PHQ-2) increased from 50.5% to 57% (p<0.00000000000000022) and rates of subsequent screening with PHQ-9, for those scoring at risk, defined as a score of ≥1, on PHQ-2, increased from 34.5% to 91.4% (p<0.00000000000000022). Additionally, high rates of ‘moderate’ and ‘severe’ symptoms of depression (40.3%), anxiety (42.6%) and substance use (26.7% alcohol; 31.2% other substance use) were observed among PC patients.ConclusionsResults suggest that a comprehensive implementation plan, including digitisation of BH assessment, reduced the burden of systematic screening. High rates of BH symptomatology underscore the need for comprehensive BH assessment and systems planning to address the high need for BH services among PC patients.

scholarly journals Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kelli Thoele ◽  
Laura Moffat ◽  
Stephanie Konicek ◽  
Monika Lam-Chi ◽  
Erica Newkirk ◽  
...  
Keyword(s):  
Primary Care ◽  
Brief Intervention ◽  
Scoping Review ◽  
Implementation Strategies ◽  
Implementation Process ◽  
The United States ◽  
Healthcare Settings ◽  
Primary Care Settings ◽  
Implementation Outcomes ◽  
Prevention And Treatment

Abstract Background Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.

scholarly journals Providing food to patients in primary care to induce weight loss: a systematic literature review

2021 ◽  
pp. bmjnph-2020-000195
Author(s):  
Lauren Ball ◽  
Mari Sommerville ◽  
Jennifer Crowley ◽  
Zoe Calleja ◽  
Katelyn Barnes
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Assessment Tool ◽  
Public Health Practice ◽  
Primary Care Clinic ◽  
Or Education ◽  
Eligibility Criteria ◽  
High Quality Research ◽  
Care Clinic ◽  
Primary Care Settings

PurposePrimary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight.MethodsFour databases were searched for studies that aimed to elicit weight loss by directly providing foodstuffs and/or supplements to patients in primary care settings. Interventions with adults of any gender or race were included. Interventions that involved other components such as exercise classes or education sessions were excluded. The methodological quality of each study was appraised using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.ResultsFour heterogeneous studies met the eligibility criteria, representing 476 adults. Two studies used meal-replacement products but differed in length and intensity, another study provided green tea and vitamin E supplementation, and the final study provided vouchers for use at a farmers’ market hosted at a primary care clinic. Interventions ranged in length from 4 to 13 weeks. Three of the four studies observed weight loss in some form and all studies observed at least one other improvement in a health outcome such as waist circumference, blood pressure or fasting insulin levels.ConclusionsA small yet notable body of literature supports the concept of providing food to patients in primary care settings to support weight loss. Further, high-quality research is needed on the efficacy and cost-effectiveness of this approach to ultimately inform policy initiatives for primary care.

scholarly journals Evaluating the implementation of a primary care intervention to reduce prescriptions of benzodiazepines (BENZORED IV)

2021 ◽  
Author(s):  
Isabel Socias ◽  
Alfonso Leiva ◽  
Haizea Pombo-Ramos ◽  
Ferran Bejarano ◽  
Ermengol Sempere-Verdú ◽  
...  
Keyword(s):  
Primary Care ◽  
Traffic Accidents ◽  
Implementation Strategies ◽  
Developed Countries ◽  
Successful Implementation ◽  
Implementation Climate ◽  
Primary Care Settings ◽  
The Individual

Abstract Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type 1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze facilitator and barriers to implement the intervention to primary care settings.Methods: Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate and analyze the dataResults: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: The complexity in the intervention, the individual Stage of Change and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: the adaptability in the intervention, the external policy and incentives, the implementation climate, the relative priority, the self-efficacy and formally appointed implementation leader engaging. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.Conclusion: We identified constructs that could explain the variation in the implementation of the intervention, this information is relevant to design successful implementation strategies to implement the intervention.

scholarly journals Efficacy of a Web-Based Intervention to Improve and Sustain Knowledge and Screening for Amblyopia in Primary Care Settings

2011 ◽  
Vol 52 (10) ◽  
pp. 7160 ◽  
Author(s):  
Wendy L. Marsh-Tootle ◽  
Gerald McGwin ◽  
Connie L. Kohler ◽  
Robert E. Kristofco ◽  
Raju V. Datla ◽  
...  
Keyword(s):  
Primary Care ◽  
Web Based ◽  
Primary Care Settings

scholarly journals Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

2010 ◽  
Vol 2 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Olawale O. Ogunsemi ◽  
Francis A. Oluwole ◽  
Festus Abasiubong ◽  
Adebayo R. Erinfolami ◽  
Olufemi E. Amoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Primary Health ◽  
Patient Health ◽  
The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

Brief substance use screening instruments for primary care settings

2000 ◽  
Vol 18 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Tracy L McPherson ◽  
A.B.D ◽  
Rebekah K Hersch
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Screening Instruments ◽  
Primary Care Settings

A Web Based Education Program in Adolescent Depression and Suicide for Primary Care Physicians

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Kutcher
Keyword(s):  
Primary Care ◽  
Education Program ◽  
Primary Care Physicians ◽  
Educational Program ◽  
Adolescent Depression ◽  
Web Based ◽  
Primary Care Settings ◽  
Care Intervention ◽  
Clinical Tools ◽  
Web Based Education

Adolescent depression and suicide are two important and related issues that can be effectively addressed by primary care physicians who have received appropriate training which includes the use of simple clinical tools that can be applied in usual primary care settings. This presentation reviews the evidence pertaining to primary care intervention for adolescent depression and suicide and provides a detailed description of a new Canadian web-based educational program for primary care physicians in the domain of adolescent depression and suicide.

scholarly journals Insights Provided by Depression Screening Regarding Pain, Anxiety, and Substance use in a Veteran Population

2020 ◽  
Vol 11 ◽  
pp. 215013272094912 ◽  
Author(s):  
Elizabeth R. Stevens ◽  
Medha Mazumdar ◽  
Ellen C. Caniglia ◽  
Maria R. Khan ◽  
Kailyn E. Young ◽  
...  
Keyword(s):  
Substance Use ◽  
Likelihood Ratio ◽  
Test Performance ◽  
Pain Interference ◽  
Depression Screening ◽  
Predictive Values ◽  
Pain Anxiety ◽  
Additional Information ◽  
Primary Care Settings ◽  
Patient Health

Objective: We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use. Methods: Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for associations between positive depression screening result cutoffs and clustering conditions. We assessed the test performance characteristics (likelihood ratio value, positive predictive value, and the percentage of individuals correctly classified) of a positive Patient Health Questionnaire (PHQ-9 & PHQ-2) depression screen for the identification of pain interference symptoms, anxiety, and substance use. Results: A total 7731 participants were included in the analyses. The median age was 50 years. The PHQ-9 threshold of ≥20 was strongly associated with pain interference symptoms (OR 21.6, 95% CI 17.5-26.7) and anxiety (OR 72.1, 95% CI 52.8-99.0) and yielded likelihood ratio values of 7.5 for pain interference symptoms and 21.8 for anxiety and positive predictive values (PPV) of 84% and 95%, respectively. A PHQ-9 score of ≥10 still showed significant associations with pain interference symptoms (OR 6.1, 95% CI 5.4-6.9) and symptoms of anxiety (OR 11.3, 95% CI 9.7-13.1) and yet yielded lower likelihood ratio values (4.36 & 8.24, respectively). The PHQ-9 was less strongly associated with various forms of substance use. Conclusion: Depression screening provides substantial additional information regarding the likelihood of pain interference symptoms and anxiety and should trigger diagnostic assessments for these other conditions.

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