Depression Screening in Primary Care: Using HIT for Patients with Limited English

描述(申请人提供)：初级保健中抑郁症的患病率很高。初级保健医生是大多数抑郁症患者的最初接触点，但据估计，只有大约一半的抑郁症患者在接受护理时得到了识别和治疗。语言障碍会进一步加剧这一问题。在美国，大约有5400万人在家中说英语以外的语言，超过2100万人的英语水平有限。语言障碍可能会导致对患者心理健康需求的讨论减少，转介到专门的心理健康服务机构的人数也会减少。然而，健康信息技术(HIT)的最新进展可能会促进在英语水平有限的患者中筛查精神健康问题的新方法。这项研究中的HIT干预措施将包括四个部分：1)为提供者提供基于网络的培训；2)对抑郁症和创伤后应激障碍患者进行多媒体电子筛查；3)为医疗保健提供者提供即时电子通知系统，并与患者的电子健康记录(EHR)相结合；以及4)提供者临床决策支持。在初级保健环境下的一项随机对照试验中，我们将评估多成分健康信息技术干预的潜力，以改善东南亚LEP人群中抑郁症和创伤后应激障碍的筛查率、临床检测、提供者开始治疗和患者结局。我们还将检查这项技术对英语能力有限的患者及其提供者的可用性和可接受性。最后，我们将确定和评估广泛实施和传播HIT干预措施的潜在促进者和障碍。这项技术有可能适用于任何一组有限的英语水平(LEP)患者，无论他们的母语是什么，并且有可能被提供者改编为在不同的初级保健环境中帮助识别、诊断和治疗精神健康问题的提供者。

DESCRIPTION (provided by applicant): The prevalence of depression in primary care is high. Primary care physicians serve as the initial point of contact for most patients with depression, yet it is estimated that only about half of the depressed patients who present for care are recognized and treated. Language barriers can further exacerbate this problem. Approximately 54 million people in the United States speak a language other than English at home and over 21 million are limited English-language proficient (LEP). Language barriers may result in less discussion about patients' mental health needs, and fewer referrals to specialty mental health services. Recent advances in health information technology (HIT), however, may facilitate novel ways to screen for mental health problems among limited English proficient patients. The HIT intervention in this study will have four components: 1) web- based training for the providers; 2) multimedia electronic screening of patients for depression and PTSD; 3) immediate electronic notification system for the health care providers and integration with the patients' electronic health records (EHR); and 4) provider clinical decision support. In a randomized, controlled trial in a primary care setting, we will assess the potential of a multi-component health information technology intervention to improve the screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder among LEP Southeast Asians. We also will examine the usability and acceptability of this technology to patients with limited English skills and their providers. Finally, we will identify and evaluate potential facilitators and barriers to wide spread implementation and dissemination of the HIT intervention. This technology has the potential to be adapted and utilized for any group of limited English-language proficient (LEP) patients, regardless of their native language, and has the potential to be adapted for providers to aid in the recognition, diagnosis, and treatment of mental health problems in diverse primary care settings.