对患者和照护者进行系统性抑郁和焦虑筛查：在囊性纤维化诊所的实施和流程改进。
Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic.
机构信息
Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
出版信息
BMJ Open Qual. 2021 May;10(2). doi: 10.1136/bmjoq-2020-001333.
INTRODUCTION
Depression and anxiety are common. Rates are significantly higher in cystic fibrosis (CF), and impact health outcomes. Screening is recommended, but is difficult to implement/sustain annually in a busy CF centre. The aim was to develop an acceptable model for depression and anxiety screening in adolescents/adults with CF and their caregivers that could be sustained and shared.
METHODS
Quality improvement methodology with plan-do-study-act cycles, flow diagrams, review of data monthly with our designated 'Mental Health Team' and caregiver satisfaction surveys, were used to begin screening in clinics and to improve the process. We then piloted our process at a larger paediatric CF centre.
RESULTS
Prior to 2013, screening was not performed at our CF centre. After the first quarter of depression screening, 88% of adolescents and 69% of adults with CF were screened. The process was refined. By the second year, 99% of patients were screened. Anxiety screening began in year three; 97%-99% of patients were screened for both anxiety and depression in years 3-5. Annual caregiver screening rates were >95%. Screening was changed from Patient Health Questionnaire-2 (PHQ-2) to PHQ-9 due to better sensitivity in caregivers, and expanded to patients. Anxiety screening began in year 3 with the Generalised Anxiety Disorder-7 questionnaire. Patients and caregivers reported acceptance of screening. At the larger paediatric centre used as a pilot, 89.6% of patients were screened in year 1. Feedback included recommendations to improve tracking/follow-up of positive screens.
CONCLUSIONS
Development and implementation of a stepwise process for depression and anxiety screening was successful in a paediatric/adult CF clinic, due to constant re-evaluation by an engaged team with feedback from patients via survey. A systematic approach at a busy CF centre can serve as a model to implement screening in a clinic.
简介
抑郁和焦虑很常见。在囊性纤维化（CF）中，这些症状的发生率显著更高，并会影响健康结果。建议进行筛查，但在繁忙的 CF 中心，每年实施/维持筛查都很困难。本研究旨在为 CF 青少年/成年患者及其照护者开发一种可接受的抑郁和焦虑筛查模型，使其能够持续进行，并与他人共享。
方法
采用质量改进方法，通过计划-执行-研究-行动循环、流程图、每月与指定的“心理健康团队”审查数据以及照护者满意度调查，在诊所开始进行筛查，并改进流程。然后，我们在更大的儿科 CF 中心试点该流程。
结果
在 2013 年之前，我们的 CF 中心没有进行筛查。在开始抑郁筛查的第一个季度后，88%的 CF 青少年和 69%的成年患者接受了筛查。该过程得到了改进。第二年，99%的患者接受了筛查。第三年开始进行焦虑筛查；在第 3-5 年，97%-99%的患者接受了焦虑和抑郁的年度筛查。年度照护者筛查率>95%。由于照护者的敏感性更好，将患者健康问卷-2（PHQ-2）改为 PHQ-9 进行筛查，并将其扩展至患者。第三年开始使用广泛性焦虑障碍-7 问卷进行焦虑筛查。患者和照护者都表示接受了筛查。在用作试点的更大的儿科中心，第一年有 89.6%的患者接受了筛查。反馈意见包括改进对阳性筛查的跟踪/随访的建议。
结论
在儿科/成人 CF 诊所中，通过一个积极参与的团队不断进行重新评估，并通过调查从患者处获得反馈，成功开发并实施了抑郁和焦虑筛查的逐步流程。在繁忙的 CF 中心采取系统方法可以为在诊所实施筛查提供模型。
Zotero 插件