在儿科专科诊所中实施抑郁筛查和全球健康评估。
Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics.
机构信息
Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California.
出版信息
J Adolesc Health. 2017 Nov;61(5):591-598. doi: 10.1016/j.jadohealth.2017.05.030. Epub 2017 Aug 19.
PURPOSE
Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics.
METHODS
A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care.
RESULTS
Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening.
CONCLUSIONS
A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.
目的
患有慢性病的青少年面临更大的心理社会困难风险，这使疾病管理变得复杂。尽管越来越多地呼吁对患者报告的结果进行筛查，但临床实施却滞后了。本研究采用质量改进方法，旨在调查标准化筛查抑郁和评估总体健康状况的可行性，并确定跨三个儿科亚专科诊所推荐的行为健康随访。
方法
共有 109 名年龄在 12-22 岁（中位数=16.6）的患者接受了门诊治疗，用于治疗糖尿病（80%为 1 型）、炎症性肠病或囊性纤维化，他们在电子平板电脑上完成了 9 项患者健康问卷（PHQ-9）抑郁和患者报告的结果测量信息系统（PROMIS）儿科总体健康测量。在 PHQ-9 上筛查阳性的患者接受当天的行为健康评估和定期电话检查，以促进必要的后续护理。
结果
总体而言，在 6 个月的时间窗口内，122 名确定患者中有 89%完成了筛查。患者及时完成了测量（在 3 分钟内），不会中断门诊流程，他们认为该过程简单、舒适且有价值。疾病类型不同，抑郁评分也不同。患者的总体健康评分相对之前评估的验证队列较低。抑郁和总体健康状况与某些医疗结果显著相关。在 PHQ-9 上筛查阳性的患者中有 15%，其中 50%在筛查后 6 个月内确认参加了行为健康预约。
结论
在儿科亚专科中实施标准化的抑郁和总体健康评估方案是可行且有效的。对患有慢性疾病的青少年和年轻人进行普遍的行为健康筛查是满足儿科亚专科诊所计划需求的必要条件。
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