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A Performance Improvement Initiative for Enhancing the Care of Patients with Depression


Journal of Psychiatric Practice: July 2014 - Volume 20 - Issue 4 - p 276–283
doi: 10.1097/01.pra.0000452564.83039.69

Background. Depression is a common and potentially disabling condition, yet many patients remain undiagnosed, and many more fail to receive adequate treatment. To address this gap, clinicians must routinely evaluate patient care practices. The purpose of this study was to evaluate the effectiveness of a three- stage performance improvement (PI) continuing medical education (CME) initiative to strengthen evidence-based psychiatric practices for the screening and management of patients with depression. Methods. A total of 492 physician participants voluntarily registered to complete a three-stage initiative consisting of self-evaluation, improvement, and reevaluation. Participants were recruited through a series of faxes, e-mails, and direct-mail invitations. Results. Approximately 20% (n=86) of the registrants completed the three-stage initiative. Completers provided chart data on 2,122 patients encountered before and 2,130 patients encountered after engaging in the PI CME activity. Large gains were made in the percentage of patients screened using standardized criteria to assess depression status, particularly the Patient Health Questionnaire-2 (PHQ-2) and the PHQ-9 (26% of 1,378 patients at Stage A vs.68% of 1,711 patients at Stage C; p<0.001). Physicians were also more likely to rescreen patients 4 to 8 weeks after initial screening (48% of 1,961 patients at Stage A vs. 75% of 2,028 patients at Stage C; p<0.001) and to assess patient adherence to antidepressants using standardized measures (10% of 1,909 patients at Stage A vs. 45% of 1,740 patients at Stage C; p<0.001). Conclusions. PI CME provides insight into and aids in improving evidence-based patient care in psychiatric practices. (Journal of Psychiatric Practice 2014;20:276–283)

THASE: University of Pennsylvania School of Medicine, Philadelphia; STOWELL, MENCIA, and BLUM: Med-IQ, Baltimore, MD; BERRY: New York University School of Medicine

Acknowledgements: This manuscript is dedicated in memoriam to Victoria Street, whose vision and dedication were instrumental in the design of the educational activity. The authors thank Whitney Stevens Dollar for project management; Beth Wills for participant recruitment; Mary Catherine Downes, Samantha Roberts, and Amy Sison for outcomes management; Kenny Khoo for data management; Suzanne Jenkins for IT assistance; Christine Gray for assistance with data analysis; and Rebecca Julian for editorial assistance.

Disclosures: This initiative was supported by an unrestricted educational grant from Lilly USA, LLC. The funding source had no role in the planning, execution, analysis, or development of the educational program, the research, or the manuscript associated with this initiative. Dr. Thase discloses that he has served as a paid advisor/consultant to a number of companies with interests in the development of treatments for depression and bipolar disorder, including Alkermes, Allergan, AstraZeneca, Bristol-Myers Squibb, Dey Pharma, Eli Lilly and Company, Forest Laboratories, Inc., GlaxoSmithKline, Janssen Pharmaceuticals, Inc., F. Hoffmann-La Roche Ltd., Johnson & Johnson, Lundbeck, MedAvante, Inc., Merck & Co., Inc., Mylan Inc., Neuronetics, Inc, Novartis Pharmaceuticals Corporation, Otsuka America Pharmaceutical, Inc., Pamlab, L.L.C., PharmaNeuroBoost NV, Pfizer, Inc., PGx, Inc., Rexahn Pharmaceuticals, Inc., Schering-Plough Corporation, Shire, Sonkei Pharmaceuticals, Sunovion Pharmaceuticals, Inc., Takeda Pharmaceuticals North America, Inc., and Teva Pharmaceuticals USA; he has received grant support from the Agency for Healthcare Research and Quality, Alkermes, AstraZeneca, Eli Lilly and Company, F. Hoffmann-La Roche Ltd., Forest Laboratories, Inc., National Institute of Mental Health, NeoSync Inc., Otsuka America Pharmaceutical, Inc., and PharmaNeuroBoost NV; he has served as a paid consultant to the U.S. Food and Drug Administration and the National Institute of Mental Health; he has received honoraria for educational talks supported by AstraZeneca, Lundbeck, Mylan Inc., Otsuka America Pharmaceutical, Inc., and Pfizer, Inc. Dr. Berry discloses that she is a paid consultant to Med-IQ, LLC. The remaining authors have nothing to disclose.

Please send correspondence to: Stephanie A. Stowell, 5523 Research Park Drive, Suite 210, Baltimore, MD 21228.

© 2014 by Lippincott Williams & Wilkins, Inc.