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Using web-based technology to improve depression screening in primary care settings.

Jessica Jeffrey1, Minh-Chau T Do2, Nastassia Hajal2

  • 1Division of Population Behavioral Health, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA jjeffrey@mednet.ucla.edu.

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Summary
This summary is machine-generated.

Implementing a digital behavioral health (BH) assessment tool in primary care significantly increased screening rates for depression and anxiety. This digital approach streamlined workflows, addressing challenges in busy practices and highlighting the need for integrated BH services.

Keywords:
health behaviourhealthcare quality improvementmental healthprimary carequality improvement

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Area of Science:

  • Primary Care
  • Behavioral Health
  • Digital Health

Background:

  • Primary care settings serve as a de facto mental health system due to high patient volumes with behavioral health (BH) concerns.
  • Integrating BH screening into primary care (PC) is crucial for improving patient outcomes but faces challenges like limited time and resources.
  • Systematic screening for depression and other BH conditions in PC is a key target for enhanced patient care.

Purpose of the Study:

  • To evaluate the impact of a digital, cloud-based BH assessment tool on screening rates in urban primary care practices.
  • To assess the feasibility and effectiveness of implementation strategies, including workflow reorganization and staff training.
  • To examine the prevalence of BH symptomatology among patients receiving care in primary care settings.

Main Methods:

  • A digital, cloud-based BH assessment tool with EHR enhancements was implemented in two urban PC practices.
  • Implementation involved workflow reorganization, comprehensive staff and physician training, and an incentive program for clinic managers.
  • Screening rates were compared between January-June 2017 (pre-implementation) and January-June 2018 (post-implementation).

Main Results:

  • BH screening rates using the Patient Health Questionnaire-2 (PHQ-2) increased from 50.5% to 57%.
  • Rates of subsequent PHQ-9 screening for at-risk patients rose dramatically from 34.5% to 91.4%.
  • High prevalence of moderate to severe symptoms was observed: depression (40.3%), anxiety (42.6%), and substance use (26.7% alcohol, 31.2% other).

Conclusions:

  • A comprehensive implementation plan, including digital BH assessment, effectively reduced the burden of systematic screening.
  • The high rates of BH symptomatology confirm the critical need for robust BH assessment and integrated systems in primary care.
  • Findings support the expansion of digital BH tools to address the significant need for BH services among primary care patients.