Implementing Measurement-Based Care to Monitor Depression in Primary Care

Abstract

Problem: Major Depressive Disorder (MDD) is a prevalent clinical issue and leading cause of disability. Few providers abide by the evidence supporting frequent monitoring. At a primary care clinic in Maryland, patients under the age of 65 years old with a diagnosis of MDD are being monitored for their current symptom burden very infrequently. The Beck’s Depression Inventory-II (BDI-II) tool can be utilized as an effective method to identify symptom burden. Purpose: The purpose of this quality improvement project is to increase the number of adult patients who receive monitoring of their depressive symptoms by introducing measurement-based care via the utilization of the Beck’s Depression Inventory-II with a goal of improving individual outcomes. Methods: Two medical assistants (MAs) were educated on the basic principles of MDD and trained on the use of the BDI-II. The MAs then offered the 20-item BDI-II to all adult patients with a diagnosis of MDD coming to the clinic for any visit type. Exclusion criteria included patients who completed the questionnaire within the past month. The questionnaire responses were trended on a weekly basis. Results: There were a total of 31 eligible patients over the project period of 14 weeks. Of these patients, 58% completed the voluntary questionnaire, while 42% declined or were missed by a staff member; 72% of participants reported current symptom burden. Conclusions: Beck’s Depression Inventory-II monitoring tool is a practicable option within the primary care setting to utilize in adult patients with MDD. The project’s goal was to increase the volume of patients who received appropriate monitoring of their MDD-associated symptoms via an assessment tool. For future implementation of this project, it is ideal for others to ensure that the practice site has electronic health record capabilities and clinic practices which allows access of patients’ diagnoses, medications, past medical history, health screenings, and visit summaries.