BACKGROUND: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. OBJECTIVE: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. DESIGN: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-stroke outpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. PARTICIPANTS: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. INTERVENTIONS: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. MAIN MEASURES: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. KEY RESULTS: In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N = 278) vs. 50% of control (N = 374) patients (OR 6.2 , p < 0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p = 0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p < 0.001) and to receive a treatment action if screened positive (OR 2.45, p = 0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. CONCLUSIONS: Automated depression screening in primary and specialty care can improve detection and treatment of PSD.
RCT Entities:
BACKGROUND: Post-stroke depression (PSD) occurs in at least one-third of stroke survivors, is associated with worse functional outcomes and increased mortality, and is frequently underdiagnosed and undertreated. OBJECTIVE: To evaluate the effectiveness of an electronic medical record-based system intervention to improve the proportion of veterans screened and treated for PSD. DESIGN: Quasi-experimental study comparing PSD screening and treatment among veterans receiving post-strokeoutpatient care one year prior to the intervention (the control group) to those receiving outpatient care during the intervention period (the intervention group); contemporaneous data from non-study sites included to assess temporal trends in depression diagnosis and treatment. PARTICIPANTS: Veterans hospitalized for ischemic stroke and/or receiving primary care (PC) or neurology outpatient follow-up within six months post-stroke at two (Veterans Affairs) VA Medical Centers. INTERVENTIONS: We formed clinical improvement teams at both sites. Teams developed PSD screening and treatment reminders and designed tailored implementation strategies for reminder use in PC and neurology clinics. MAIN MEASURES: Proportion screened for PSD within 6 months post-stroke; proportion screening positive for PSD who received an appropriate treatment action within 6 months post-stroke. KEY RESULTS: In unadjusted analyses, PSD screening was performed within 6 months for 85% of intervention (N = 278) vs. 50% of control (N = 374) patients (OR 6.2 , p < 0.001), and treatment action was received by 83% of intervention vs. 73% of control patients who screened positive (OR 1.8 p = 0.13). After adjusting for intervention, site and number of follow-up visits, intervention patients were more likely to be screened (OR 4.8, p < 0.001) and to receive a treatment action if screened positive (OR 2.45, p = 0.05). Analyses of temporal trends in non-study sites revealed no trend toward general increase in PSD detection or treatment. CONCLUSIONS:Automated depression screening in primary and specialty care can improve detection and treatment of PSD.
Authors: John W Williams; Martha Gerrity; Tracey Holsinger; Steve Dobscha; Bradley Gaynes; Allen Dietrich Journal: Gen Hosp Psychiatry Date: 2007 Mar-Apr Impact factor: 3.238
Authors: Bradford L Felker; Edmund Chaney; Lisa V Rubenstein; Laura M Bonner; Elizabeth M Yano; Louise E Parker; Linda L M Worley; Scott E Sherman; Scott Ober Journal: Prim Care Companion J Clin Psychiatry Date: 2006
Authors: Renee F Robinson; Denise A Dillard; Vanessa Y Hiratsuka; Julia J Smith; Steve Tierney; Jaedon P Avey; Dedra S Buchwald Journal: Int J Indig Health Date: 2015
Authors: Thomas A McCormick; John L Adams; Eric A Lee; Nicholas P Emptage; Darryl E Palmer-Toy; John P Martin; Benjamin I Broder; Michael H Kanter; Anna C Davis; Elizabeth A McGlynn Journal: EGEMS (Wash DC) Date: 2019-08-26