A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

Abstract

Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

“…Ongoing training, coaching, and monitoring of office staff by practice and clinical leaders as well as EHR data captures and transparency in reporting ongoing screening rates are critical to the success of PPM screening. Moreover, the introduction of patient technologies, such as tablets, piloted in our health system offers an additional way to improve patient-reported screening measures (Last et al, 2021). Ambulatory care leaders must also solicit regular feedback about barriers to screening practices and involve providers and staff in developing solutions to overcome them.…”

Promoting youth mental health through stakeholder-generated innovation

“…In response to these calls to action, an abundance of ideas for promoting youth mental health have been proposed. Youth mental health advocates have emphasized the urgent need to screen for youth mental health problems to identify and address symptoms and other sequelae before they begin to interfere with functioning (Guo & Jhe, 2021;Last et al, 2021); to widely disseminate information about mental illness and available welfare and mental health resources to improve recognition and prevention of mental health problems (Kelly et al, 2007;Lasecke et al, 2022); to increase the availability and accessibility of mental health resources, particularly for under-resourced and marginalized communities (Atkins et al, 2017;Torres Sanchez et al, 2022); to recruit, train, and employ more mental health professionals (Barnett et al, 2018;Konrad et al, 2009); and to increase funding to turn these ideas for promoting youth mental health into a reality (Cooper & Aratani, 2009). A glaring issue, however, is that it is not possible to immediately and simultaneously invest, implement, and sustain all of these avenues for promoting youth mental health within the current mental healthcare infrastructure.…”

“…This process has long been used by companies to select which products to develop, by movie studios to select which pitches to fund, and by competition shows, such as American Idol, to select the winning contestant. More recently, implementation scientists have used innovation tournaments to crowdsource ideas from clinicians for solving intractable problems in mental healthcare (Last et al, 2021;Sibley et al, 2022). For example, Stewart and colleagues (2019) used an innovation tournament to solicit ideas from clinicians on how their agencies could support the use of evidence-based practices.…”

Academic health science networks' experiences with rapid implementation practice during the COVID-19 pandemic in England

“…The approach holds the promise of a paradigm shift to close the knowledgeto-practice gap more efficiently and rapidly (2). It might allow those involved in implementing changes to "fail fast" and quickly adapt their implementation strategy to the dynamic real-world contextual changes characterizing the complex health and social care systems in which implementation takes place (1,3,4). Smith et al's (2) conceptualization is focusing on accelerating the research process, however, our understanding how to apply it in implementation practice is only just starting to emerge.…”

“…Rapid approaches applied in implementation science are covering mainly rapid data collection and analysis methods. For example, Davis and colleagues (2021) reflected on the application of rapid ethnography for contextual assessments in implementation studies (5), and Last et al (3) described a pilot study of rapid prototyping for refining implementation strategies. Other examples for rapid methods relevant to implementation science are rapid randomized controlled trials, rapid qualitative analyses, rapid-cycle evaluations, or rapid review methods (6)(7)(8)(9)(10).…”