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Müller F, Abdelnour AM, Rutaremara DN, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care. PLoS One 2024; 19:e0301125. [PMID: 38547139 PMCID: PMC10977679 DOI: 10.1371/journal.pone.0301125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Screening for mental health problems has been shown to be effective to detect depression and initiate treatment in primary care. Current guidelines recommend periodic screening for depression and anxiety. This study examines the association of patient sociodemographic factors and clinic characteristics on mental health screening in primary care. DESIGN In this retrospective cohort study, electronic medical record (EMR) data from a 14-month period from 10/15/2021 to 12/14/2022 were analyzed. Data were retrieved from 18 primary care clinics from the Corewell Health healthcare system in West Michigan. The main outcome was documentation of any Patient Health Questionnaire (PHQ-4/PHQ-9/GAD-7) screening in the EMR within the 14-month period at patient level. General linear regression models with logit link function were used to assess adjusted odds ratio (aOR) of having a documented screening. RESULTS In total, 126,306 unique patients aged 16 years or older with a total of 291,789 encounters were included. The prevalence of 14-month screening was 79.8% (95% CI, 79.6-80.0). Regression analyses revealed higher screening odds for patients of smaller clinics (<5,000 patients, aOR 1.88; 95% CI 1.80-1.98 vs. clinics >10.000 patients), clinics in areas with mental health provider shortages (aOR 1.69; 95% CI 1.62-1.77), frequent visits (aOR 1.80; 95% CI, 1.78-1.83), and having an annual physical / well child visit encounter (aOR 1.52; 95% CI, 1.47-1.57). Smaller positive effect sizes were also found for male sex, Black or African American race, Asian race, Latinx ethnicity (ref. White/Caucasians), and having insurance through Medicaid (ref. other private insurance). DISCUSSION The 14-month mental health screening rates have been shown to be significantly lower among patients with infrequent visits seeking care in larger clinics and available mental health resources in the community. Introducing and incentivizing mandatory mental health screening protocols in annual well visits, are viable options to increase screening rates.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
- Spectrum Health Family Medicine Clinic, Grand Rapids, MI, United States of America
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Alyssa M. Abdelnour
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Diana N. Rutaremara
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Eric D. Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States of America
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Harland T. Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
- Spectrum Health Family Medicine Clinic, Grand Rapids, MI, United States of America
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Park N, Gundlach C, Judge T, Batavia AS, Charney P. Expanding Access to Psychiatric Care Through Universal Depression Screening: Lessons from an Urban Student-Run Free Clinic. J Community Health 2023; 48:932-936. [PMID: 37400658 DOI: 10.1007/s10900-023-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
The purpose of this study is to report the utility of a universal depression screening in a student-run free clinic (SRFC) to improve bridging to psychiatric care. Patients (n = 224) seen by an SRFC between April 2017 and November 2022 were screened for depression in the patient's primary language using the standardized Patient Health Questionnaire (PHQ-9). A PHQ-9 score greater or equal to 5 prompted psychiatry referral. Retrospective chart review was conducted to determine clinical characteristics and length of psychiatry follow-up. Out of 224 patients screened, 77 patients had positive depression screens and were referred to the SRFC's adjacent psychiatry clinic. Of these 77 patients, 56 patients (73%) were female, the average age was 43.7 (SD = 14.5), and the mean PHQ score was 10 (SD = 5.13). Thirty-seven patients (48%) accepted referral, while 40 (52%) declined or were lost to follow-up. There were no statistical differences in age or number of medical comorbidities between the two groups. Patients who accepted referrals were more likely to be female, as well as to have psychiatric histories, higher PHQ-9 scores, and a history of trauma. Reasons for declining and being lost to follow-up included transition to insurance, geographic relocation and deferral due to hesitancy in seeking psychiatric care. Implementation of a standardized depression screening reveals a significant rate of depressive symptoms among an urban uninsured primary care population. Universal screening may serve as a tool to improve the delivery of psychiatric care to underserved patients.
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Affiliation(s)
- Nana Park
- Weill Cornell Medical College, New York, NY, USA.
| | | | - Tyler Judge
- Weill Cornell Medical College, New York, NY, USA
| | - Ashita S Batavia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Müller F, Abdelnour AM, Rutaremara DN, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study. J Prim Care Community Health 2023; 14:21501319231200304. [PMID: 37714820 PMCID: PMC10504842 DOI: 10.1177/21501319231200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To assess differences in mental health screening based on patient's preferred language. METHODS For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened. RESULTS Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients (P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients. CONCLUSIONS Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think "needs" a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients' preferred language.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Alyssa M. Abdelnour
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Diana N. Rutaremara
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Eric D. Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Harland T. Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
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Staab EM, Wan W, Campbell A, Gedeon S, Schaefer C, Quinn MT, Laiteerapong N. Elements of Integrated Behavioral Health Associated with Primary Care Provider Confidence in Managing Depression at Community Health Centers. J Gen Intern Med 2022; 37:2931-2940. [PMID: 34981360 PMCID: PMC9485335 DOI: 10.1007/s11606-021-07294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression is most often treated by primary care providers (PCPs), but low self-efficacy in caring for depression may impede adequate management. We aimed to identify which elements of integrated behavioral health (BH) were associated with greater confidence among PCPs in identifying and managing depression. DESIGN Mailed cross-sectional surveys in 2016. PARTICIPANTS BH leaders and PCPs caring for adult patients at community health centers (CHCs) in 10 midwestern states. MAIN MEASURES Survey items asked about depression screening, systems to support care, availability and integration of BH, and PCP attitudes and experiences. PCPs rated their confidence in diagnosing, assessing severity, providing counseling, and prescribing medication for depression on a 5-point scale. An overall confidence score was calculated (range 4 (low) to 20 (high)). Multilevel linear mixed models were used to identify factors associated with confidence. KEY RESULTS Response rates were 60% (N=77/128) and 52% (N=538/1039) for BH leaders and PCPs, respectively. Mean overall confidence score was 15.25±2.36. Confidence was higher among PCPs who were satisfied with the accuracy of depression screening (0.38, p=0.01), worked at CHCs with depression tracking systems (0.48, p=0.045), had access to patients' BH treatment plans (1.59, p=0.002), and cared for more patients with depression (0.29, p=0.003). PCPs who reported their CHC had a sufficient number of psychiatrists were more confident diagnosing depression (0.20, p=0.02) and assessing severity (0.24, p=0.03). Confidence in prescribing was lower at CHCs with more patients living below poverty (-0.66, p<0.001). Confidence in diagnosing was lower at CHCs with more Black/African American patients (-0.20, p=0.03). CONCLUSIONS PCPs who had access to BH treatment plans, a system for tracking patients with depression, screening protocols, and a sufficient number of psychiatrists were more confident identifying and managing depression. Efforts are needed to address disparities and support PCPs caring for vulnerable patients with depression.
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Affiliation(s)
| | - Wen Wan
- University of Chicago, Chicago, IL, USA
| | | | - Stacey Gedeon
- Mid-Michigan Community Health Services, Houghton Lake, MI, USA
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Arundell LL, Greenwood H, Baldwin H, Kotas E, Smith S, Trojanowska K, Cooper C. Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators. Syst Rev 2020; 9:115. [PMID: 32456670 PMCID: PMC7251669 DOI: 10.1186/s13643-020-01333-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care. METHODS A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included. RESULTS Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints. CONCLUSIONS The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making. SYSTEMATIC REVIEW REGISTRATION Not applicable.
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Affiliation(s)
- Laura-Louise Arundell
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB UK
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Helen Greenwood
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Helen Baldwin
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Eleanor Kotas
- York Economics Consortium, University of York, Heslington, York, YO10 5DD UK
| | - Shubulade Smith
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Kasia Trojanowska
- National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB UK
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB UK
- Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
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Schaeffer AM, Jolles D. Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community. Jt Comm J Qual Patient Saf 2018; 45:31-39. [PMID: 30139563 DOI: 10.1016/j.jcjq.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Screening for depression and documenting follow-up is a National Quality Forum-endorsed measure. Yet only seven states report depression screening and follow-up, making it the fourth-least-reported measure on the Medicaid Adult Core Set. In 2016 a multicultural health center found that only 9.1% of clients were screened and followed up for depression. This quality improvement project was conducted to increase the efficacy of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for depression to 75% for screen-positive clients. METHODS Four Plan-Do-Study-Act (PDSA) cycles in a 90-day period focused on depression screening, patient engagement, population health management, and team building were used. The package of interventions-use of written standardized Patient Health Questionnaire (PHQ) screening tools in six languages, the Option Grid™ for clients with positive PHQ screens, a "right care" tracking log for those clients, and team meetings and in-services to support capacity building-were operationalized using a point-of-care notebook that created a physical reminder and trigger for the use of the intervention tools. Surveys, charts, and registry data were analyzed to evaluate the population health impact of the interventions. RESULTS Provision of evidence-based care increased to 71.4%, and adherence to follow-up increased from 33.3% to 60.0%. Screening in the client's preferred language increased the rate to 85.2%, identifying a positive PHQ incidence of 45.5%. CONCLUSION Rapid-cycle improvement with a population health focus demonstrated improved depression screening and follow-up within a multicultural community health center. Outcomes were attributed to team engagement and the use of standardized tools. These processes can be applied to other primary care settings.
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