Dataset Information

The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits.

ABSTRACT:

Background

Primary care providers encounter a large proportion of the population with depression. Yet, many primary care patients with depression remain undiagnosed and untreated.

Objective

This study aims to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting.

Design

This is a cross-sectional analysis of nationally representative survey data of visits to outpatient physician offices from the 2005 to 2015 National Ambulatory Medical Care Surveys.

Participants

The sample included the first visit in the past year to a primary care provider by patients 12 years and older (N?=?16,887).

Methods

The associations of visit characteristics with depression screening and of depression screening with depression diagnosis and treatment during the visit were assessed using logistic regression. Logistic regression with propensity score weighting was used to estimate the odds of depression diagnosis and treatment under the counterfactual scenario in which patients who visited providers with lower depression screening rates had visited providers with higher screening rates instead. All models were adjusted for patient and visit characteristics.

Key results

A small proportion of sample visits involved depression screening (3.0%). Visits by patients with depressive symptom complaints were associated with higher odds of depression screening than other visits. When visits were weighted to have similar demographic and clinical characteristics, visits to providers with higher screening rates had higher odds of diagnosis (OR?=?1.99, p?ConclusionsPhysicians appear to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment, and even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care. Future research is needed to identify barriers to depression care and implement systematic interventions to improve services and patient outcomes.

SUBMITTER: Samples H

PROVIDER: S-EPMC6957618 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits.

Samples Hillary H Stuart Elizabeth A EA Saloner Brendan B Barry Colleen L CL Mojtabai Ramin R

Journal of general internal medicine 20190806 1

<h4>Background</h4>Primary care providers encounter a large proportion of the population with depression. Yet, many primary care patients with depression remain undiagnosed and untreated.<h4>Objective</h4>This study aims to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting.<h4>Design</h4>This is a cross-sectional analysis of nationally representative survey data of visits to outpatient physician offices fr ...[more]

PMID: 31388917

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Project description:AIMS:Unhealthy alcohol use is common among adults, and in particular, Veterans. Routine alcohol screening followed by brief intervention is recommended and considered a prevention priority in primary care settings. While previous studies have found that Veterans enrolled in the Veteran's Health Administration (VA) receive high rates of screening and brief intervention, less than 50% of Veterans receive VA health care. No study has evaluated receipt of these services in a general sample of Veterans. Therefore, in a nationally-representative sample, we examine whether Veteran status was associated with receiving alcohol screening and brief intervention in primary care. METHODS:Using the Centers for Disease Control and Prevention's 2014 Behavioral Risk Factor Surveillance System data, we identified adults who endorsed visiting a doctor for routine checkup at least once in the past two years and responded to an optional module assessing alcohol-related care (N?=?92,206; 14.1% Veterans). Multivariable logistic regression was used to assess the association between Veteran status and screening and brief intervention outcomes. We also evaluate differences in alcohol-related care across Veteran status stratified by gender. Models were adjusted for sociodemographic and clinical characteristics likely to confound the association. RESULTS:Overall, Veterans were more likely than non-Veterans to be screened for alcohol quantity and heavy episodic drinking (ps?<?0.05), and more likely to endorse receiving brief intervention advice about alcohol's harmful effects (p?<?.001). Veteran status predicted an increased likelihood of being screened and receipt of advice about alcohol's harmful effects, but did not predict the likelihood of receiving advice to reduce or abstain from drinking (AOR?=?1.00, 95% C.I. [0.80-1.26]). Analyses stratified by gender indicated a similar pattern of results for males as the overall sample. Results among females indicated Veteran status predicted the likelihood of being asked about heavy episodic drinking (AOR?=?1.47, 95% C.I. [1.09-1.99]) and being offered advice about the harmful effects of alcohol (AOR?=?1.62, 95% C.I. [1.06-2.48]). Female Veterans were not more likely than female non-Veterans to be advised to reduce and/or abstain from drinking. CONCLUSIONS:Screening about any alcohol use was common while report of screening for quantity and heavy episodic drinking occurrence and report of brief intervention were less common. Veterans were more likely than non-Veterans to report receiving recommended care, though rates of advice to reduce or abstain from drinking did not differ across groups. Persistent gaps in delivery of recommended alcohol-related care, especially for particularly vulnerable subpopulations such as women Veterans, suggest a need for quality improvement.

Project description:BackgroundManaging depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown.ObjectiveIn a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression.Design and participantsWe conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n?=?27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients.Main measuresWe assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1.Key resultsAmong those who did not receive depression treatment in Y1 (n?=?4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n?=?22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2.ConclusionsIn a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.

Dataset Information

The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits.

Background

Objective

Design

Participants

Methods

Key results

Publications

The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits.

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