Increasing Patient Knowledge Engagement to Improve Depression Care

Increasing Patient Knowledge & Engagement to Improve Depression Care Ross, E. , Talbot, J. , Van. Dyke, P. , Van Wyk, K. , & Waanders, A. Clinton Family Health Team Opportunity Statement Intervention/Change Ideas Patients: • Play an important role in their healthcare • Lack knowledge about effective self administered improvement methods • Need encouragement to play an active role in improving functioning & symptoms The goal of this project was to ensure that patients had access to education and selfmanagement tools immediately upon diagnosis. We developed a package of self management tools, completed an assessment, and then followed up with patients within 2 weeks of diagnosis to ensure immediate supports where in place. Aim Statement To encourage improvements in markers of depression (i. e. , symptoms and functioning) in the first 2 months after diagnosis by: • Providing standardized information package (or “Depression Toolkit”) • Reinforcing and tracking patient’s goals and efforts Ultimately, reducing PHQ-9 endorsed symptoms by 5 points in the first 2 months after identification of depression or MDD Diagnostics Sustainability & Spread Results During IDEAS We have learned that sustainability within our research team is paramount to the ultimate sustainability of project objectives • Regular meetings for adoption, encouragement, and accountability • Having Toolkit easily accessible and given to all patients with MDD • Greater improvements in PHQ-9 scores (i. e. , 6. 3 points) over initial 2 months, compared to baseline • Engaged patients in adjunct therapies and self-management strategies • Learned that exercise, sleep hygiene, and nutrition were the most preferred self guided interventions • Patients felt the Depression Toolkit did not add to their knowledge necessarily; however, it prompted them towards action and accountability of that action More specifically, we added ‘service’ during time patient waited for psychotherapy or for medication to work by: 1. Providing “Depression Toolkit” -Standard info about MDD and adjunct therapies 2. Introducing scale of functioning -Not just symptoms of MDD 3. Care tracking device for all practitioners Three Step Spread approach: 1) Core team regularly using developed tools 2) Invitation and support of extended team (i. e. , NP and mental health worker) to use tools 3) Invitation to nurses and physicians to implement tools Additional IMPACT Focus on patients with MDD lead to: • Examination of mental health triage process • All patients are now contacted in first 2 weeks after referral • Chance for intervention • Toolkit, adjunct therapies, community referrals Measures Process measures: Goal was 80% of patients have: • Current PHQ-9 = 100% • Sheehan Disability scale = 81% • Depression toolkit at dx = 81% • Toolkit reviewed with patient = 78% • Depression Flowsheet on EMR = 100% Need to provide support and encouragement at each step! Successes/ Next Steps Successes • All patients referred to mental health services are contacted within 2 weeks by team member • Patients are regularly administered a measure of functioning and disability Change in PHQ-9 • An average of 6 point improvement between initial MDD diagnosis and 2 month follow-up after intervention • Represents greater improvement in symptoms compared to baseline Process map of journey of patient and care providers after diagnosis of MDD Next Steps • Extend to use for anxiety as well Chart Legend: • Negative scores represent worsening of symptoms and positive scores represent improvements in symptoms over the 2 months • Green vertical line denotes time of intervention Contact 18. 2 Changes in PHQ-9 Scores Over 2 months Name: Dr. Erin Ross Title: Psychologist Organization: Clinton Family Health Team Email: eross@claritypsych. ca Phone: 519. 482. 3000 13. 2 Changes in PHQ-9 Scores 8. 2 3. 2 1 2 3 4 5 6 7 8 9 10 11 -1. 8 -6. 8 -11. 8 -16. 8 Patients 12 13 14 15 16 17 18 19 20 21