University of Texas Health Science Center at San Antonio.
Workplace Health Saf. 2022 Dec;70(12):543-550. doi: 10.1177/21650799221119147. Epub 2022 Oct 10.
Depression in the U.S. population affects approximately 17.5 million people, with an approximate annual economic cost of US$326 billion. The overall objective of this quality improvement program was implementation of a standardized screening protocol using a validated screening instrument to identify depression in first responders in a primary care setting.
This program applied the Knowledge-to-Action framework utilizing the 9-question Patient Health Questionnaire (PHQ-9) screening tool. The outcome measure was screening completion with a process measure of depression questionnaires provided to patients, and balance measures of time of visit and referral rate. In a pre-/postintervention project design, clinic staff were trained on depression screening. PHQ-9 questionnaires were placed in all exam rooms for patients and providers to discuss. Referrals were made to the staff psychologist or to medical providers based on evaluations.
From pre- to postintervention, screening increased from less than 1% to a screening rate of 92%. Appointments for depression intervention increased to 50%, 44 patients for counseling and 12 for medical therapy.
CONCLUSIONS/APPLICATIONS TO PRACTICE: A standardized screening protocol using a validated self-assessment tool improved depression surveillance and increased referrals for treatment. A training program with an accompanying policy was designed to sustain this program and may serve as a model for other programs serving first responders.
美国约有 1750 万人患有抑郁症，其年经济成本约为 3260 亿美元。本质量改进计划的总体目标是在初级保健环境中使用经过验证的筛选工具实施标准化的筛选方案，以识别急救人员中的抑郁症。
本项目应用知识转化框架，采用 9 项患者健康问卷（PHQ-9）筛选工具。评估指标为完成筛选，过程指标为向患者提供抑郁问卷，平衡指标为就诊时间和转诊率。在干预前后的项目设计中，对诊所工作人员进行了抑郁症筛查培训。在所有诊室为患者和医务人员准备了 PHQ-9 问卷以供讨论。根据评估结果，将患者转介给工作人员心理学家或医疗服务提供者。
与干预前相比，干预后筛查率从不足 1%提高到 92%。接受抑郁干预的预约增加到 50%，44 名患者接受咨询，12 名患者接受药物治疗。
结论/对实践的应用：使用经过验证的自我评估工具的标准化筛选方案可改善抑郁监测，并增加治疗转介。设计了一个培训计划和配套政策，以维持该计划，也可作为为急救人员服务的其他计划的模型。
