Depression Screening in a Primary Care Practice in Oregon

Depression is a serious and common mental illness in primary care. Regardless of the improvements in depression management, depression in many patients is still unrecognized. Routine screening for depression among adults in primary care is recommended by the U.S Preventive Service Task Force, as long as healthcare organizations are equipped with staff-assisted depression support systems. The purpose of this dissemination pilot project was to evaluate the routine use of the PHQ-9, a depression screening tool, among adult patients presenting for annual health maintenance examinations. Additionally, increasing follow-up visits among patients with positive depression screens was also investigated. The three-week practice quality improvement project was successful in implementing a routine depression screening policy. Among patients scheduled for their annual health maintenance examination, 94% were screened for depression. All patients who self-identified as at risk for depression were screened with the PHQ-9. Among patients with positive screens, the majority were invited for follow-up care during the study. As a result of the pilot, this clinic now exclusively uses the PHQ-9 depression screening tool. Furthermore, they modified their annual health maintenance examination policy to include routine screening for depression.

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Depression Screening and Measurement-Based Care in Primary Care

Journal of Primary Care & Community Health ◽

10.1177/2150132720931261 ◽

2020 ◽

Vol 11 ◽

pp. 215013272093126

Author(s):

Kimberly A. Siniscalchi ◽

Marion E. Broome ◽

Jason Fish ◽

Joseph Ventimiglia ◽

Julie Thompson ◽

...

Keyword(s):

Primary Care ◽

Task Force ◽

Medical Center ◽

Academic Medical Center ◽

Unmet Need ◽

The United States ◽

Depression Screening ◽

Improvement Project ◽

Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

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Development and Implementation of a Postpartum Depression Screening Program in the NICU

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.39.2.75 ◽

2020 ◽

Vol 39 (2) ◽

pp. 75-82

Author(s):

Angela Taylor Vaughn ◽

Gwendolyn L. Hooper

Keyword(s):

Data Analysis ◽

Postpartum Depression ◽

Screening Tool ◽

Screening Program ◽

Routine Screening ◽

Diagnostic Evaluation ◽

Depression Screening ◽

National Organizations

Postpartum depression (PPD) is higher among NICU mothers compared to mothers without infants in the NICU. Routine screening improves early PPD identification and treatment for mothers. Key national women and infant organizations endorse facility-based policies that address PPD screening. In addition to PPD screening, the key national organizations recommend facilities providing care to women and infants develop a method of referral for maternal PPD evaluation, treatment, and follow-up. Due to the timing, onset, and maternal predisposition to PPD, the NICU is a prime setting for PPD screening. Despite recommendations, PPD screening is not routine in the NICU. This article describes the development and assessment of a PPD screening program implemented in the NICU. Data analysis of 30 NICU mothers evaluated the risk of PPD based on screening tool scores, maternal diagnostic evaluation compliance, and documentation of maternal follow-up with designated NICU staff.

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Fever in Pediatric Primary Care: Occurrence, Management, and Outcomes

PEDIATRICS ◽

10.1542/peds.105.s2.260 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 260-266

Author(s):

Jonathan A. Finkelstein ◽

Cindy L. Christiansen ◽

Richard Platt

Keyword(s):

Primary Care ◽

Laboratory Testing ◽

Office Visit ◽

Pediatric Primary Care ◽

Care Practice ◽

Meningococcal Sepsis ◽

Office Visits ◽

Health Maintenance ◽

Entire Cohort

Objective. To describe the epidemiology, management, and outcomes of children with fever in pediatric primary care practice. Patients. A cohort of 20 585 children 3 to 36 months of age cared for in 11 pediatric offices of a health maintenance organization between 1991 and 1994. Methods. Using automated medical records we identified all office visits with temperatures ≥38°C for a random sample of 5000 children, and analyzed diagnoses conferred, laboratory tests performed, and antibiotics prescribed. We also determined the frequency of in-person and telephone follow-up after initial visits for fever. Finally, we reviewed hospital claims data for the entire cohort of 20 585 to identify cases of meningitis, meningococcal sepsis, and death from infection. Results. Among 3819 initial visits of an illness episode, 41% of children had no diagnosed bacterial or specific viral source. Of these, 13% with a temperature of 38°C to 39°C and 36% with a temperature of ≥39°C received laboratory testing. Almost half (43%) received some documented follow-up care in the subsequent 7 days. Among the 26 970 child-years of observation in the entire cohort, 15 children (56 per 100 000 child-years) were treated for bacterial meningitis or meningococcal sepsis. Five had an office visit for fever in the week before hospitalization, but only 1 had documented fever ≥39°C and received neither laboratory testing for occult bacteremia nor treatment with an antibiotic. Conclusion. The majority of febrile children in ambulatory settings were diagnosed with a bacterial infection and treated with an antibiotic. Of highly febrile children without a source, 36% received laboratory testing consistent with published expert recommendations, and short-term follow-up was common. Meningitis or death after an office visit for fever without a source was predictably rare. These data suggest that increased testing and/or treatment of febrile children beyond the rates observed here are unlikely to affect population rates of meningitis substantially.

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Patient Notification of Test Results in a Primary Care Setting

Clinical Scholars Review ◽

10.1891/1939-2095.6.2.120 ◽

2013 ◽

Vol 6 (2) ◽

pp. 120-123

Author(s):

Caroline Sulllivan ◽

Janice Smolowitz

Keyword(s):

Primary Care ◽

Diagnostic Test ◽

Care Setting ◽

Primary Care Setting ◽

Safety Issue ◽

Care Practice ◽

Test Results ◽

Quality Health Care ◽

Improvement Project

The ordering and management of diagnostic test results is an important aspect of the plan of care in the primary care setting. The process involves a series of steps beginning with ordering the test and appropriate communication to ensure patient follow-up. Patient–provider communication and documentation is essential to achieve high-quality health care outcomes. The failure to communicate diagnostic test results and develop follow-up plans is an important patient safety issue. This quality improvement project examined management of diagnostic tests in a primary care practice for the purpose of improving processes of care and outcomes. The project focused on current practices, patient satisfaction, and patients’ preference relating to laboratory result communication.

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Follow-up of 100 dogs with acute diarrhoea in a primary care practice

The Veterinary Journal ◽

10.1016/j.tvjl.2013.10.014 ◽

2014 ◽

Vol 199 (1) ◽

pp. 188-190 ◽

Cited By ~ 7

Author(s):

C.M. Berset-Istratescu ◽

O.J. Glardon ◽

I. Magouras ◽

C.F. Frey ◽

S. Gobeli ◽

...

Keyword(s):

Primary Care ◽

Primary Care Practice ◽

Acute Diarrhoea ◽

Care Practice

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A Resident-driven Quality Improvement Project to Increase Primary Care Follow-up after Congestive Heart Failure Exacerbation

American Journal of Medical Quality ◽

10.1097/jmq.0000000000000037 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

Lea M. Monday ◽

Joseph Sebastian ◽

Paul Nguyen ◽

Omid Yazdanpanah ◽

Caleb Solokowski ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Congestive Heart Failure ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Heart Failure Exacerbation

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Longitudinal, multidisciplinary, resident-driven intervention to increase immunisation rates for Medicaid, low-income and uninsured patients

BMJ Open Quality ◽

10.1136/bmjoq-2020-000986 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000986

Author(s):

Cynthia Cantu ◽

Kristopher Koch ◽

Ramon S Cancino

Keyword(s):

Primary Care ◽

Low Income ◽

Primary Care Practice ◽

Care Practice ◽

Waiting Room ◽

Improvement Project ◽

Vaccination Rates ◽

Initial Intervention ◽

Risk Patients ◽

Academic Primary Care

IntroductionMore payers are closely linking reimbursement to high-value care outcomes such as immunisation rates. Despite this, there remain high rates of pneumonia and influenza-related hospitalisations generating hospital expenditures as high as $11 000 per hospitalisation. Vaccinating the public is an integral part of preventing poor health and utilisation outcomes and is particularly relevant to high-risk patients. As part of a multidisciplinary effort between family and internal medicine residency programmes, our goal was to improve vaccination rates to an average of 76% of eligible Medicaid, low-income and uninsured (MLIU) patients at an academic primary care practice.MethodsThe quality improvement project was completed over 3 months by three primary care resident groups. The setting was a suburban academic primary care practice and eligible patients were 18 years of age or older. Our aim was to increase immunisation rates of pneumococcal, influenza, varicella, herpes zoster virus and tetanus and diphtheria vaccination. There were 1690 patients eligible for the vaccination composite metric. Data were derived from the electronic health record and administrative data.InterventionsCohort 1 developed an initial intervention that consisted of a vaccine questionnaire for patients to complete while in the waiting room. Cohort 2 modified questionnaire after reviewing results from initial intervention. Cohort 3 recommended elimination of questionnaire and implementation of a bundled intervention approach.ResultsThere were minimal improvements in patient immunisation rates after using a patient-directed paper questionnaire. After implementation of multiple interventions via an improvement bundle, there were improvements in immunisation rates which were sustained and the result of special cause variation.ConclusionA key to improving immunisation rates for MLIU patients in this clinic was developing relationships with faculty and staff stakeholders. We received feedback from all the medical staff and then applied it to the interventions and made an impact in the average of vaccinations.

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Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-028491 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028491 ◽

Cited By ~ 1

Author(s):

Navneet Aujla ◽

Thomas Yates ◽

Helen Dallosso ◽

Joe Kai

Keyword(s):

Primary Care ◽

At Risk ◽

Diabetes Prevention ◽

Resource Constraints ◽

Diabetes Risk ◽

Care Practice ◽

Behavioural Intervention ◽

Specific Information ◽

Prevention Intervention

ObjectivesTo explore service-user and provider experience of the acceptability and value of the Let’s Prevent Diabetes programme, a pragmatic 6-hour behavioural intervention using structured group education, introduced into primary care practice.DesignQualitative interview-based study with thematic analysis.SettingPrimary care and community.ParticipantsPurposeful sample of 32 participants, including 22 people at high risk of diabetes who either attended, defaulted from or declined the intervention; and 10 stakeholder professionals involved in implementation.ResultsParticipants had low prior awareness of their elevated risk and were often surprised to be offered intervention. Attenders were commonly older, white, retired and motivated to promote their health; who found their session helpful, particularly for social interaction, raising dietary awareness, and convenience of community location. However attenders highlighted lack of depth, repetition within and length of session, difficulty meeting culturally diverse needs and no follow-up as negative features. Those who defaulted from, or who declined the intervention were notably apprehensive, uncertain or unconvinced about whether they were at risk of diabetes; sought more specific information about the intervention, and were deterred by its group nature and day-long duration, with competing work or family commitments. Local providers recognised inadequate communication of diabetes risk to patients. They highlighted significant challenges for implementation, including resource constraints, and facilitation at individual general practice or locality level.ConclusionsThis pragmatic diabetes prevention intervention was acceptable in practice, particularly for older, white, retired and health-motivated people. However, pre-intervention information and communication of diabetes risk should be improved to increase engagement and reduce potential fear or uncertainty, with closer integration of services, and more appropriate care pathways, to facilitate uptake and follow-up. Further development of this, or other interventions, is needed to enable wider, and more socially diverse, engagement of people at risk. Balancing a locality and individual practice approach, and how this is resourced are considerations for long-term sustainability.

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Call your doctor: prospective description study of telemedicine during the first COVID-19 outbreak in a Swiss primary care practice

10.21203/rs.3.rs-108798/v1 ◽

2020 ◽

Author(s):

Joëlle Suillot ◽

Sophie Zuercher ◽

Lydie Zufferey ◽

Julien Sagez

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Primary Care Practice ◽

Emergency Services ◽

Phone Call ◽

Categorical Variables ◽

Care Practice ◽

Or Groups ◽

Swiss Primary Care

Abstract Background: Telemedicine is a healthcare assistance method which has been promoted during the COVID-19 pandemic for the management of patients. The aim of this study is to quantify the type of request that primary care physicians are experiencing, as well as the healthcare assistance modalities and ultimately, how many physical consultations are necessary.Methods: We conducted a prospective, descriptive study in a primary care practice in Switzerland on telephone consultations related to COVID-19. The data collected included the reasons for the call, symptoms, healthcare assistance modalities and follow-up. The categorical variables are expressed as percentages of the total cases or groups.Results: We included 200 calls corresponding to 113 patients. The majority of patients (76.1%) were taken care of solely through telemedicine. The physical consultations were due to the need: for a swab test (12.4%), for a somatic assessment at the practice (9.7%) and for an emergency services consultation (1.8%). In 64.6% of cases, patient assistance required only one phone call. Calls lasted 7.85 minutes on average and were more frequent on Mondays (24%) and Fridays (18.5%). Calls led to the prescription of medication in 12.5% of cases, of a bronchodilator in 3% of cases and of an antibiotic in 0.5% of cases.Conclusion: A rigorous telephone follow-up strategy carried out by primary care physicians requires few physical consultations in patients showing symptoms of COVID-19.

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