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Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring

Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring
Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring
Background:

Since 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment.

Aim:

To examine the association between the severity scores obtained and follow-up questionnaires to monitor depression and subsequent changes made to the treatment of it.

Design and setting:

A retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within Hampshire, Wiltshire, and Southampton City primary care trusts.

Method:

Records were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral.

Results:

Controlling for the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95% confidence interval = 2.83 to 7.86).

Conclusion:

GPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research.
depression, patient monitoring, primary care
0960-1643
e451-e457
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Ali, Saima
2d9041fa-9a51-4415-b5cf-eb97850e8169
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Leydon, Gerry M.
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Ovens, Jessica
68f9b4bd-1a9a-4555-942b-229a104ea8f5
Goodall, Chris
6b210f17-da6f-4f0b-b1c4-e08bfb541e9e
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Ali, Saima
2d9041fa-9a51-4415-b5cf-eb97850e8169
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Leydon, Gerry M.
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Ovens, Jessica
68f9b4bd-1a9a-4555-942b-229a104ea8f5
Goodall, Chris
6b210f17-da6f-4f0b-b1c4-e08bfb541e9e
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Moore, Michael, Ali, Saima, Stuart, Beth, Leydon, Gerry M., Ovens, Jessica, Goodall, Chris and Kendrick, Tony (2012) Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring. British Journal of General Practice, 62 (599), e451-e457. (doi:10.3399/bjgp12X649151). (PMID:22687239)

Record type: Article

Abstract

Background:

Since 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment.

Aim:

To examine the association between the severity scores obtained and follow-up questionnaires to monitor depression and subsequent changes made to the treatment of it.

Design and setting:

A retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within Hampshire, Wiltshire, and Southampton City primary care trusts.

Method:

Records were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral.

Results:

Controlling for the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95% confidence interval = 2.83 to 7.86).

Conclusion:

GPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research.

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More information

Published date: 1 June 2012
Keywords: depression, patient monitoring, primary care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 206459
URI: http://eprints.soton.ac.uk/id/eprint/206459
ISSN: 0960-1643
PURE UUID: 5b07cc77-3ac6-459c-878d-ff0ffce6a214
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Gerry M. Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

Catalogue record

Date deposited: 21 Dec 2011 11:47
Last modified: 09 Nov 2021 03:14

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Contributors

Author: Michael Moore ORCID iD
Author: Saima Ali
Author: Beth Stuart ORCID iD
Author: Gerry M. Leydon ORCID iD
Author: Jessica Ovens
Author: Chris Goodall
Author: Tony Kendrick ORCID iD

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