Improving Adolescent Depression Screening in Pediatric Primary Care

Valerie S Harder; Sara E Barry; Sarah French; Alyssa B Consigli; Barbara L Frankowski

doi:10.1016/j.acap.2019.02.014

Improving Adolescent Depression Screening in Pediatric Primary Care

Acad Pediatr. 2019 Nov-Dec;19(8):925-933. doi: 10.1016/j.acap.2019.02.014. Epub 2019 Mar 9.

Authors

Valerie S Harder¹, Sara E Barry², Sarah French², Alyssa B Consigli², Barbara L Frankowski²

Affiliations

¹ Departments of Pediatrics (VS Harder, SE Barry, S French, AB Consigli, and BL Frankowski); Psychiatry (VS Harder), Vermont Child Health Improvement Program, University of Vermont, Burlington. Electronic address: Valerie.Harder@med.uvm.edu.
² Departments of Pediatrics (VS Harder, SE Barry, S French, AB Consigli, and BL Frankowski).

PMID: 30858080
DOI: 10.1016/j.acap.2019.02.014

Abstract

Objective: Depression among adolescents is a leading public health problem. Although screening for adolescent depression in primary care is strongly recommended, screening rates remain low. Effective quality improvement (QI) initiatives can facilitate change. This study aims to assess the impact of a QI learning collaborative on adolescent depression screening and initial plans of care in primary care.

Methods: Seventeen pediatric-serving practices in Vermont participated in a QI learning collaborative aimed at improving practitioner knowledge and office systems around adolescent depression screening. Monthly medical record reviews provided monitoring of adolescent depression screening and initial plans of care over 7 months for QI. Randomly sampled annual medical record review data allowed comparison of screening and initial plans of care after the QI learning collaborative between participating and 21 control practices.

Results: As practices improved their office systems around adolescent depression screening and initial plans of care, data showed marked improvement in depression screening at all 17 practices, from 34% to 97% over 7 months. Adolescents at participating practices had 3.5 times greater odds (95% confidence interval [CI], 1.14-10.98, P = .03) of being screened for depression and 37.5 times greater odds (95% CI, 7.67-183.48, P < .0005) of being screened with a validated tool than adolescents at control practices, accounting for patient characteristics.

Conclusions: There were significant within practice increases in adolescent depression screening after a QI learning collaborative, as well as in comparison with control practices 1 year later.

Keywords: adolescent mental health; primary care; quality improvement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Depression / diagnosis*
Depression / therapy
Depressive Disorder / diagnosis*
Depressive Disorder / therapy
Family Practice
Female
Humans
Male
Mass Screening
Patient Health Questionnaire
Pediatrics*
Primary Health Care*
Quality Improvement
Vermont