Practice-Based Learning and Systems-Based Practice: Detection and Treatment Monitoring of Generalized Anxiety and Depression in Primary Care

Abstract

Objectives Quality assurance/quality improvement projects are an important part of professional development in graduate medical education. The purpose of our quality improvement study was to evaluate whether (1) the Generalized Anxiety Disorder (GAD-7) scale questionnaire increases detection of anxiety and (2) the Quick Inventory for Depressive Symptomatology Self Report (QIDS-SR) increases detection of depression in a primary care setting. We also aimed to determine whether monitoring patients with depression or generalized anxiety using the QIDS-SR and GAD-7 scales influences treatment changes in the primary care setting. Methods Patients seen in a general internal medicine clinic between August 2008 and March 2009 were asked to fill out the QID-SR questionnaire and GAD-7 as part of a resident quality improvement project. We measured the prevalence of anxiety and depression during 6 months prior to the use of the GAD-7 and QIDS-SR instruments during the intervention period. We also compared the frequency of treatment changes initiated both 12 months prior to and during the intervention period. The aforementioned measures were performed with use of a retrospective chart review. Results The prevalence of anxiety was 15.2% in the pre-intervention period and 33.3% in the intervention period, and the prevalence of depression was 38.9% in the prescreening period and 54.8% during the screening period (P value for both was <0.001). The change in anxiety therapy was 21.6% in the prescreening period and 62.2% in the screening period (P = .028). The change in depression therapy was 23.2% in the pre-intervention period and 52.1% in the intervention period (P = .025). Conclusion Routine screening for depression and anxiety may help clinicians detect previously undiagnosed anxiety and depression and also may facilitate identification of needed treatment changes. Further work is needed to determine whether routine screening improves patient outcomes.

A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience

“…To address these challenges, a number of authors have provided alternative concepts [2] and various methods of teaching and evaluation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. One internal medicine's residency review committee created education innovations projects to allow certain residency programs to develop new curricula to teach competencies such as SBP [4].…”

“…The report consisted with the following contents with the maximum of 5 single-spaced pages excluding references: (1) title of the SBP issue, (2) case presentation, (3) SBP competencies at stake, (4) diagram of the event occurred in the case, (5) evaluation of the literature, (6) proposed solutions for the SBP issue, and (7) bibliography.…”

“…It is important for future clinicians to advocate for their patients and identify health care system deficiencies. Residency programs in all disciplines across the United States have developed specific interventions and curricula to teach SBP and have attempted to evaluate residents in this competency domain [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. To date, however, no long-term analysis of SBP projects within a residency program has been performed.…”

Where do we go from here? Moving from systems-based practice process measures to true competency via developmental milestones

“…1 ). After the above search strategies, removal of duplicates, and a thorough screening using inclusion and exclusion criteria, 29 articles were included in the systematic review ( 8 – 36 ). Given the exploratory nature of this study, we had little basis for organizing these studies ( 5 ).…”

Interventions to improve the detection of depression in primary healthcare: systematic review

“…The screening tools were mostly administered by nurses, general practitioners and research assistants. In some studies, screening tools were self-administered [47,51], and scoring was done by either nurse assistants or healthcare providers.…”