Improving the identification and treatment of depression in low-income primary care clinics: a qualitative study of providers in the VitalSign6 program
Improving the identification and treatment of depression in low-income primary care clinics: a qualitative study of providers in the VitalSign6 program
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DOI：
10.1093/intqhc/mzy128
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发表时间：
2019-02-01
影响因子：
2.6
通讯作者：
Trivedi, Madhukar H.
中科院分区：
文献类型：
--
作者：
Kahalnik, Farra;Sanchez, Katherine;Trivedi, Madhukar H.
质量问题：尽管它的全球负担和流行，重性抑郁症往往不被发现和治疗，特别是在初级保健setting.Initial评估普遍：四分之一的得克萨斯州人缺乏医疗保险，和行为健康障碍的人受到不成比例的影响。在初级保健环境中提供高质量的抑郁症治疗是可能的，其结果与专科护理提供的结果相同。抑郁症研究和临床护理中心提供了一个机会，可以改变服务不足的初级保健实践中的服务提供实践，以改善质量，健康状况，患者体验和协调。一种基于网络的即时护理自我报告软件程序VitalSign 6，旨在在初级保健实践中提供普遍的抑郁症筛查，并协助提供者使用以下原则监测和治疗患者的症状实施：实施包括多方面的培训计划，旨在建立参与诊所的医疗提供者和工作人员的信心和能力，以及VitalSign 6团队提供的持续绩效改进。评估：采用半结构化访谈指南，对初级保健提供者（N = 11）进行了访谈，重点关注全面整合的障碍和挑战，对该计划最有价值/最不有价值方面的看法，以及该计划对抑郁症筛查和治疗的知识、态度和行为的影响。经验教训：需要更有效的技术来减少浪费的时间，以及培训来减少耻辱和纠正对抗抑郁药物的误解。供应商买入是必不可少的。结论：尽管障碍，VitalSign 6增加了知识，改变态度，提高供应商的抑郁症筛查和治疗技能随着时间的推移。
Quality problem: Despite its global burden and prevalence, Major Depressive Disorder often goes undetected and untreated, and is particularly pervasive in the primary care setting.Initial assessment: One in four Texans lack health insurance, and people with behavioral health disorders are disproportionately affected. It is possible to provide high-quality depression treatment in primary care settings with outcomes equal to those provided by specialty care. The Center for Depression Research and Clinical Care offered an opportunity to transform service delivery practices in underserved primary care practices to improve quality, health status, patient experience and coordination.Choice of solution: A point-of-care, web-based, self-report based software program, VitalSign6, was developed to provide universal depression screening in primary care practices and assist providers in monitoring and treating patients' symptoms using principles of Measurement-Based Care.Implementation: Implementation included a multi-faceted training program designed to build confidence and competence in participating clinics' medical providers and staff as well as ongoing performance improvement delivered by the VitalSign6 team.Evaluation: Primary care providers (N = 11) were interviewed, using a semi-structured interview guide, with a focus on barriers and challenges to full integration, perceptions of the most/least valuable aspects of the program, and the program's impact on knowledge, attitudes and behaviors about depression screening and treatment.Lessons learned: More efficient technology is needed to reduce time wasted, as is training to reduce stigma and correct misconceptions about antidepressant medications. Provider buy-in is essential.Conclusions: Despite barriers, VitalSign6 increased knowledge, changed attitudes and enhanced providers' depression screening and treatment skills over time.