A new performance improvement initiative for physicians has been found to significantly increase their use of evidence-based practices in screening for and treating depression.
In a new study, Dr. Michael E. Thase of the University of Pennsylvania Medical School and colleagues evaluated a continuing medical education program to increase physicians’ use of practices that have been shown to improve diagnosis and care for depression.
The three-stage initiative, reported in the Journal of Psychiatric Practice, started with a review of 50 patients for each participating doctor.
The initial review step assessed the physicians’ consistency with a set of evidence-based performance measures, including comparison with the performance of other participants.
Based on this feedback, each physician developed a personal plan to improve patient care.
The plans were to be implemented over a three-month period, during which time the clinicians received educational and support materials.
After three months, participants underwent a repeat review to assess changes in performance. The physicians could earn educational credits for completing each step of the program.
Four hundred ninety-two US psychiatrists and primary care physicians registered and completed the first stage of the program. Of these, 86 physicians completed all three steps of the initiative.
Those who did complete the program showed substantial improvements in their management of depression.
The percentage of physicians using standardized criteria to screen their patients for depression increased from 26 percent at the first chart review to 68 percent at the follow-up review.
The percentage performing recommended follow-up screening also increased from 48 to 75 percent.
The educational initiative was also associated with increased use of standardized measures to assess adherence to antidepressant treatment from 10 to 45 percent.
Many patients stop taking prescribed antidepressants within the first few months, and use of standardized measures allow for more reliable assessments that may promote increased adherence to treatment.
One in three US adults will experience a major depressive episode during their lifetime, yet a quarter of patients are undiagnosed, and fewer than half of those who are diagnosed receive treatment.
There are research-proven practices to improve management of depression, but some clinicians have been slow to adopt these recommendations.
The new approach seeks to help doctors incorporate new evidence into routine care through practice-based learning.
The current study supports this approach, showing substantial improvements in adherence to guideline-based practice by physicians who complete all three steps of the initiative.
The results highlight the significant gap between how doctors perceive their performance and their “real world performance,” as reflected in patient charts.
“Improvements in patient care through the use of clinician self-assessment, goal setting, and reassessment suggest clinicians achieved greater awareness and knowledge of evidence-based measures,” Dr. Thase and coauthors conclude.
Researchers further studies to understand why a high percentage of physicians started but did not complete the program — previous studies suggest that the initial self-evaluation step may be the “key component” in improving performance.
Source: Wolters Kluwer Health
This article first appeared on PsychCentral on 21 July 2014.