As many readers are aware, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry declared a national mental health emergency in October of 2021 after an increase in suicide rates and diagnoses of anxiety and depression, among many other mental health conditions. That is why this article from Garbutt et al is so timely (10.1542/peds.2021-051107). The authors describe a quality improvement (QI) project conducted among 11 different primary care practices in the St. Louis, MO metropolitan area that led to improved follow-up care for adolescents (12-17 years of age) who have depression.
The authors’ primary aim was to increase the percentage of patients who were seen within 6 weeks of their depression diagnosis and within 3 months once the patient was stabilized. Secondary outcomes included the percentage of teens with a PHQ-A document at follow-up, remission of depression at 6 months, and provider confidence in their ability to provide care for patients with depression.
Data was collected from 416 during this 12-month intervention. The team utilized an external practice facilitator to inform providers about their current mental health service practice patterns (including care delivery, documentation, and billing) and compared them to the Guidelines for Adolescent Depression in Primary Care. This facilitator also helped organize ongoing meetings as the practices worked through multiple Plan-Do-Study-Act cycles. The authors estimate that this intervention would be approximately $60,000 to hire the facilitator which they suggest may be reduced by using virtual platforms. Cost-savings would likely be realized via the use of pre-recorded facilitation sessions without the need for a hired facilitator to travel to multiple practice locations.
The authors found that there was a statistically significant increase (40% to 81%) in the percentage of newly diagnosed patients who had follow-up within 6 weeks (40% to 81%) and at 3 months (30% to 60%). Additionally, there was a statistically significant increases in the secondary outcomes of remission of depression in 6 months (7% to 21%), provider confidence in managing depression (40% to 87%) in their patients, and in the percentage of patients who had a PHQ-A recorded.
Garbutt et al highlight the difficulty of implementing change and the disparity in ability of some practices to fully realize the change goals. Lacking a control group, the authors correctly highlight that the observed changes seen on the primary and secondary outcomes could not be fully attributable to the intervention. Despite this limitation, the study indicates that we are in the midst of a mental health emergency and need to seriously consider all evidence-based interventions to improve the mental health care we provide to our patients.