Session number: 1042
Abstract title: Improving the Rate of Depression Treatment in Primary Care Using Electronic Medical Records
Author(s):
JC Fortney - HSR&D Center for Mental Healthcare and Outcomes Research
JM Pyne - HSR&D Center for Mental Healthcare and Outcomes Research
Objectives: The objective of this ongoing pilot study is to determine whether electronic
medical records can be used to increase the rates of detection and treatment
of major depressive disorder (MDD) by primary care physicians (PCPs).
Methods: CPRS was used to identify veterans with up-coming primary care appointments at
the Little Rock VAMC who screened positive for depression in the past year.
Ninety four percent (n=236) of patients screening positive who were not
currently in treatment completed the PHQ9 prior to their appointment to assess
depression severity. To date, 28 patients (11.9%) met diagnostic criteria for
MDD and 93% (n=26) consented to be randomized to one of three groups: usual care
(UC), screening only (SO) and screening and treatment recommendations (S&TR).
Patients in the SO group had a progress note placed in CPRS to be cosigned by
their PCP before their upcoming visit documenting their responses to PHQ9 items.
Patients in the S&TR group had a progress note placed in CPRS noting PHQ9
responses along with guideline-concordant antidepressant treatment
recommendations. Electronic medical records were examined to determine whether
patients had been assigned a depression diagnosis, prescribed an antidepressant
or discussed depression symptoms with their PCP.
Results: In the usual care group, 42.9% of patients had depression addressed during the
visit (e.g., diagnosis, prescription or discussion). In contrast, 75.0% and
63.6% of patients in the SO and S&TR groups, respectively, had depression
addressed during the visit. Combining patients in the two intervention groups
and comparing them to the usual care group (42.9% versus 68.4%) yielded a
chi-square statistic of 1.4 (p=0.23). Given the anticipated final sample size
of 75 patients, these results should be statistically significant if the trend
holds.
Conclusions: Preliminary results from this ongoing pilot study strongly suggest that
electronic medical records can be effectively used to improve the detection and
treatment of MDD in primary care settings.
Impact statement: Although MDD is prevalent in primary care settings, it frequently goes
undetected and untreated. Paper and pencil screening programs have historically
not improved the detection and treatment rates of depression. However,
electronic medical record systems have the potential to efficiently communicate
diagnostic information to PCPs.