how to conduct an effective phq2 & phq9 … to conduct an effective phq2 & phq9 depression...
TRANSCRIPT
How to Conduct an Effective PHQ2 & PHQ9
Depression Screening
Algorithm & Protocol for Treatment of Depression
Richard Maye, MBA & Dr. John Mason
May 31, 2017
Disclaimer
Medical Advantage Group would like to disclose that no one
is in a position to control or influence the content of this
activity has reported relevant financial relationships with
commercial interests.
The information and guidelines contained in this activity are
generalized and may not apply to all practice situations.
Medical Advantage Group recommends that legal advice be
obtained from a qualified attorney for specific application to
your practice. The information is intended for educational
purposes and should be used as a reference guide only.
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Housekeeping
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Objectives
Recognize the need to make depression screening an
expected office practice in primary care
Understand the screening tools
Learn how to utilize the results to direct the patient
toward the proper care pathway
Become acquainted with the treatment approaches for
depression
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Rate of Depression Screening in Primary Care
In 2012-2013 only 4.2%
of adults were screened
for depression (1)
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4.2% 47%
Of the primary care
visits that screened for
depression, 47%
resulted in a new
depression diagnosis (1)
Missed Opportunities
This suggests that screening may be prompted
by a suspicion of depression, causing a
significant number of patients to be missed that
do NOT display or disclose symptoms(1)
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African-American
patients were half
as likely to be
screened as white
patients
Elderly patients
were half as likely
to be screened as
middle aged
patients
Prevalence of
major
depression in
adolescents
rose 37% from
2005 to 2014(2)
Patients with
chronic conditions
were more likely
to be screened(1)
50%LESS
37%CHRONIC+
Rate of Depression Screening in Primary Care
(cont.)
50%LESS
Why?
Asking behavioral health questions to patients may not
come naturally to staff trained for the primary care
environment
Mental health resources may be limited
Screening could be viewed as additional work that
takes too much time
If screening results are significant, what now?
The significant relationship between mental and
physical health is NOT given the weight it should be
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Strategy for Improvement
Collect and analyze your existing data
If you use an EMR for patients to electronically register
for an appointment, include the screening tools in that
process
Include the screening tools in new patient packets
along with basic educational materials that identify
symptoms
Train all staff on the relationship between mental and
physical health
Train all staff to recognize common signs of depression
and anxiety
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ASSESSING DEPRESSION
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The Criteria for Making a Referral to Behavioral Health
PHQ9 Algorithm #1
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A quick and easy instrument for screening, diagnosing,
and monitoring the severity of depression
Self-administered test, so very little additional time
spent with patient
Tool rates the frequency of symptoms which factors
into the scoring severity index
Scoring is quick and can be done by anyone
Instrument can be used as a post and pre-treatment
measure to measure progress
Results are easy to understand
PHQ9 Algorithm #1 cont.
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Consists of 9 questions, scored on a scale of 1 to 3
– 0 = none
– 1 = several days
– 2 = more than half the days
– 3 = nearly every day
Time frame of past 2 weeks
Step 1 – questions 1 and 2, one or both endorsed as 2 or 3
Step 2 – add points for each column
Step 3 – review severity score per the table
10 to 20 points suggest depression at various severities
PHQ2 can be used as a preliminary test, but has limited value
since it only contains 2 questions
PHQ9 provides more robust assessment
PHQ9 Algorithm #2
Other factors to consider when identifying depression
should be taken into consideration, and these make up
Algorithm 2
All 6 items are rated 0 through 3, with 3 being the most
critical
– Add these numbers to the PHQ9 total – if higher than 14,
a behavioral health referral should be made
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PHQ9 Algorithm #2 cont.
Administering psychotropic medication and no
progress – 3
Clinical presentation – how does the patient look and
behave in a clinical setting? – 0-3
Suicidal ideations – requires immediate referral
Past treatment, hospitalizations, severity based on
number of times and recent treatments – 0-3
How long in therapy? Longer = more critical. – 0-3
Is depression situational in nature? i.e. loss of relative,
trauma, divorce, lost job, etc. – 0-3
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Therapy Techniques
Many different therapy approaches in the treatment of
depression
As with treating all mental health issues, the use of
research-supported approaches are the most desired
A good therapist is eclectic – that is, a pro who can shift
approaches to fit the client’s needs
In today’s clinical practice, cognitively based
approaches are the first choice.1. Rational Emotive Therapy – involves challenging irrational beliefs and
the development of rational beliefs to deal with mental health problems
2. Cognitive Behavioral Therapy – involves restructuring thought
processes and beliefs to gain a more rational approach to problem
solving
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Summary
Prevalence of depression is well documented and
requires attention by the primary care providers
Mental illness begins at an early age
Early intervention can improve the mental and physical
health of patients
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QUESTIONS
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References
1. Open Minds Article; “What’s With the 4.2%?”, March
24, 2017. Citation: “National Rates and Patterns of
Depression Screening in Primary Care: Results From
2012 and 2013, by Ayse Akincigil, Ph.D. and Elizabeth
B. Mathews, M.S.W. ; from the National Ambulatory
Medicare Care Survey of 2102-2013
2. Open Minds Article: “Prevalence of Major Depression
In Adolescents Rises 37% From 2005 To 2014:
Citation: “National Trends in the Prevalence and
Treatment in Adolescents and Young Adults” by Ramin
Mojtabai, Mark Olfson and Beth Han.
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Upcoming Webinars
Algorithm for Treatment of Anxiety, June 13 at 12pm
Algorithm & Education on Management of Patients with
Chronic Pain & Addiction, June 28 at 12pm
Register at www.medadvgrp.com/events
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