scholarly journals Standardized Follow-up Plan For Depression Through The Implementation Of Provider Note And Nurse Follow-up Phone Call Templates

2021 ◽  
Vol 5 (1) ◽  
pp. 22-35
Author(s):  
Farrah Lee Rosentreader
Keyword(s):  
Primary Care ◽  
Phone Call ◽  
Mild Depression ◽  
Positive Screen ◽  
Know How ◽  
Depressed Patients ◽  
Primary Care Settings ◽  
Before And After ◽  
Patient Health

Background: Depression is highly prevalent in primary care settings and depressed patients of all ages are seen by their Primary Care Provider (PCP) for treatment (Datto et al., 2003).  In order to adequately treat depression, PCPs must follow the clinical guidelines for follow-up.Purpose: The purpose of this project was to implement a standardized follow-up plan for patients aged 12 and older with a positive screen for depression using the Patient Health Questionnaire (PHQ-9) screening tool.Methods: The setting was a rural clinic in Broken Bow, Nebraska.  The sample included 89 patients seen between September 1 -November 30, 2020 who met the criteria of a PHQ-9 score of 5 or greater compared with 47 patients seen between September 1 -November 30, 2019. Quantitative data was analyzed using descriptive statistics, frequency and means and compared between before and after implementation of this quality improvement project.Results: In 2019, 11.3 % of patients reported depression. That more than doubled to 25.6 % in 2020.  Of the depressed patients in 2019, 36.2% had mild depression, while the number almost doubled to 60.7% in 2020. The 2020 PHQ-9 results were reviewed from most severe down to mild depression.  Of the 35 patients with the highest severity, 89% had at least one measure completed representing an adequate follow-up plan.  Referral rates improved from 12.8% in 2019 to 14.6% in 2020.  Medication was the most common treatment in both years with 57.4% in 2019 and 27% in 2020.  Completed follow-ups improved from 45.5% in 2019 to 73% in 2020; with 1 nurse phone call follow-up and one CSSR-S completed.Conclusion: It is unknow the affects from the 2020 pandemic.  However, and increase in mild depression shows a need to know how to treat sub-threshold depression. The use of the template as a guide led to improvement on all measures. However, some measures were used only sparingly and use may be improved with increased acceptance of the guide.  

scholarly journals Incidence of depression in people with newly diagnosed tuberculosis in Ethiopia: a cohort study

2020 ◽  
Vol 7 ◽  
Author(s):  
Fentie Ambaw ◽  
Rosie Mayston ◽  
Charlotte Hanlon ◽  
Atalay Alem
Keyword(s):  
Protective Factor ◽  
Treatment Guidelines ◽  
Incidence Rates ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Primary Care Settings ◽  
Tb Treatment ◽  
Patient Health ◽  
Probable Depression

Abstract Background Cross-sectional studies show that the prevalence of comorbid depression in people with tuberculosis (TB) is high. The hypothesis that TB may lead to depression has not been well studied. Our objectives were to determine the incidence and predictors of probable depression in a prospective cohort of people with TB in primary care settings in Ethiopia. Methods We assessed 648 people with newly diagnosed TB for probable depression using Patient Health Questionnaire, nine-item (PHQ-9) at the time of starting their anti-TB medication. We defined PHQ-9 scores 10 and above as probable depression. Participants without baseline probable depression were assessed at 2 and 6 months to measure incidence of depression. Incidence rates per 1000-person months were calculated. Predictors of incident depression were identified using Poisson regression. Results Two hundred and ninety-nine (46.1%) of the participants did not have probable depression at baseline. Twenty-two (7.4%) and 26 (8.7%) developed depression at 2 and 6 months of follow up. The incidence rate of depression between baseline and 2 months was 73.6 (95% CI 42.8–104.3) and between baseline and 6 months was 24.2 (95% CI 14.9–33.5) per 1000 person-months respectively. Female sex (adjusted β = 0.22; 95% CI 0.16–0.27) was a risk factor and perceived social support (adjusted β = −0.14; 95% CI −0.24 to −0.03) was a protective factor for depression onset. Conclusion There was high incidence of probable depression in people undergoing treatment for newly diagnosed TB. The persistence and incidence of depression beyond 6 months need to be studied. TB treatment guidelines should have mental health component.

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.

scholarly journals Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings

2019 ◽  
Vol 26 (1) ◽  
pp. e100088
Author(s):  
Rebecca G Mishuris ◽  
Joseph Palmisano ◽  
Lauren McCullagh ◽  
Rachel Hess ◽  
David A Feldstein ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Implementation Barriers ◽  
Clinical Workflow ◽  
Primary Care Settings ◽  
Registration Number

BackgroundEffective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of ‘work’ necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and ‘work’ of implementation of two clinical decision support (CDS) tools across diverse care settings.MethodsWe conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions’ primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time.ResultsThe median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers’ participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008).ConclusionsThis study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies.Trial registration numberNCT02534987.

Improving developmental care in primary practice for disadvantaged children

2018 ◽  
Vol 104 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Karen Margaret Edmond ◽  
Scarlette Tung ◽  
Kimberley McAuley ◽  
Natalie Strobel ◽  
Daniel McAullay
Keyword(s):  
Primary Care ◽  
Geographic Location ◽  
Primary Objective ◽  
Developmental Care ◽  
Disadvantaged Children ◽  
Continuous Quality ◽  
Primary Care Settings ◽  
Mental Stimulation ◽  
Primary Practice

Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of ‘basic developmental care’ to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3–59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3–11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24–59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed.

scholarly journals A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study

2019 ◽  
Vol 10 ◽  
pp. 215013271986515
Author(s):  
Mika Lehto ◽  
Katri Mustonen ◽  
Jarmo Kantonen ◽  
Marko Raina ◽  
Anna-Maria K. Heikkinen ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Service ◽  
Service Use ◽  
Age Groups ◽  
The Public ◽  
Before And After ◽  
Care Systems ◽  
Gp Visits ◽  
A Minor

This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were ( a) application of ABCDE-triage combined with public guidance on the proper use of EDs, ( b) cessation of a minor supplementary ED, and finally ( c) application of “reverse triage” with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.

scholarly journals Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Idar Mappangara ◽  
Andriany Qanitha ◽  
Cuno S. P. M. Uiterwaal ◽  
Jose P. S. Henriques ◽  
Bastianus A. J. M. de Mol
Keyword(s):  
Primary Care ◽  
Female Gender ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Primary Care Settings ◽  
Lower Blood ◽  
History Of ◽  
Primary Care Patients ◽  
Male Patients

Abstract Background Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients.

scholarly journals Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Tuomo Lehtovuori ◽  
Timo Kauppila ◽  
Jouko Kallio ◽  
Anna M. Heikkinen ◽  
Marko Raina ◽  
...  
Keyword(s):  
Primary Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Follow Up Study ◽  
Primary Care Teams ◽  
Before And After ◽  
Quasi Experimental ◽  
Clinically Significant ◽  
Made In

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

scholarly journals Do Adolescents Consider Mind-Body Skills Groups an Acceptable Treatment for Depression: Results from a Pilot Study.

2020 ◽  
Author(s):  
Lindsey Jones ◽  
Eduardo F. Salgado ◽  
Matthew C. Aalsma ◽  
Jennifer M. Garabrant ◽  
Julie K. Staples ◽  
...  
Keyword(s):  
Primary Care ◽  
Adolescent Depression ◽  
Treatment Preference ◽  
After School ◽  
Depression Symptoms ◽  
Post Intervention ◽  
Primary Care Settings ◽  
The Social ◽  
New Treatment

Abstract Background: Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods: Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results: A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions: Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group. Trial Registration: NCT03363750

Sign in / Sign up

Export Citation Format

Share Document