Identification and Management of Adolescent Depression in a Large Pediatric Care Network
Identification and Management of Adolescent Depression in a Large Pediatric Care Network
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DOI：
10.1097/dbp.0000000000000750
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发表时间：
2020-02-01
影响因子：
2.4
通讯作者：
Young, Jami F.
中科院分区：
文献类型：
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作者：
Farley, Alyssa M.;Gallop, Robert J.;Young, Jami F.
目的：初级保健已被推广为识别和管理青少年抑郁的一种环境。这项研究检查了基于初级保健的青少年抑郁症的识别和当发现升高的症状时的后续护理。方法：数据来自一个大型儿科护理网络，组织建议在16岁时使用电子健康记录(EHR)整合的标准化测量方法筛查抑郁症。分析检查了筛查和升高症状的比率、儿科医生对升高的评分的初始反应，以及一年多来接受的随访护理类型，使用回溯性EHR数据提取和手动图表审查。结果：在不同的计划地点，76.3%(n=6981)的患者参加了他们16岁的探视。大约四分之一的人得分较高(6.7%为轻度，19.2%为中度至重度)，其中许多人在他们的良好访问日期得到了积极的随访。根据EHR摘录，在一年多的时间里，四分之三的评分在中到重度范围内的患者和40.0%的评分在轻度范围内的患者接受了随访治疗(例如，抗抑郁药处方)。根据手工图回顾，随访率较高。结论：在不同的初级保健地点进行常规的青少年抑郁筛查是可行的。得分升高的大多数患者还没有接受行为健康服务，这表明筛查发现了以前没有发现的担忧。反过来，许多得分升高的青少年在筛查后开始治疗，这表明在护理点提供筛查结果可能有助于儿科医生的行动。尽管如此，后续护理方面的差距表明，需要对以初级保健为基础的行为健康服务进行更大的投资，以支持高质量的治疗，并最终减轻青少年抑郁症的负担。
Objective: Primary care has been promoted as a setting to identify and manage adolescent depression. This study examined primary care-based adolescent depression identification and follow-up care when elevated symptoms were identified. Methods: Data came from a large pediatric care network with an organizational recommendation to screen for depression at age 16 well-visits using an electronic health record (EHR)-integrated standardized measure. Analyses examined rates of screening and elevated symptoms, pediatricians' initial responses to elevated scores, and types of follow-up care received over 1 year using retrospective EHR data extraction and manual chart reviews. Results: Across program sites, 76.3% (n = 6981) of patients attending their age 16 well-visits were screened. About one-quarter had an elevated score (6.7% mild and 19.2% moderate-to-severe), many of whom received active follow-up on their well-visit date. Over 1 year, three-fourths of patients with scores in the moderate-to-severe range and 40.0% of patients with scores in the mild range received follow-up care (e.g., antidepressant prescriptions) as per EHR extraction. Follow-up rates were higher as per manual chart reviews. Conclusion: Routine adolescent depression screening is feasible across diverse primary care sites. Most patients with elevated scores were not already receiving behavioral health services, suggesting screening identified previously undetected concerns. In turn, many adolescents with elevated scores initiated treatment after screening, which indicates providing screen results at the point of care may facilitate pediatrician actions. Still, gaps in follow-up care demonstrate the need for greater investment in primary care-based behavioral health services to support high-quality treatment and ultimately decrease the burden of adolescent depression.