Performance improvement program helps doctors better manage depression, reports journal of psychiatric practice

Study shows increased use of treatment and screening recommendations after three-step initiative

2014-07-18

(Press-News.org) A performance improvement initiative for physicians can significantly increase their use of evidence-based practices in screening for and treating depression, in the July Journal of Psychiatric Practice. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Led by Dr Michael E. Thase of the University of Pennsylvania Medical School, the researchers evaluated a performance improvement continuing medical education (PI CME) program to increase physicians' use of practices that have been shown to improve diagnosis and care for depression. The three-stage PI CME initiative, developed by Med-IQ in Baltimore, was based on an American Medical Association model for providing CME.

Three-Step Program Provides Feedback on Depression Care The process 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 CME 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 PI CME 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 PI CME initiative was also associated with increased use of standardized measures to assess adherence to antidepressant treatment: from ten 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.

PI CME Approach Helps Doctors Incorporate Evidence into Practice Depression is a common and potentially disabling condition that can be difficult to treat. 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 PI CME approach seeks to help doctors incorporate new evidence into routine care through practice-based learning.

The new study supports this approach, showing substantial improvements in adherence to guideline-based practice by physicians who complete all three steps of the PI CME 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. They suggest further studies to understand why a high percentage of physicians started but did not complete the PI CME program; previous studies suggest that the initial self-evaluation step may be the "key component" in improving performance.

Click here to read "A Performance Improvement Initiative for Enhancing the Care of Patients with Depression."

INFORMATION: About Journal of Psychiatric Practice Journal of Psychiatric Practice®, a peer reviewed journal, publishes reports on new research, clinically applicable reviews, articles on treatment advances, and case studies, with the goal of providing practical and informative guidance for clinicians. Mental health professionals will want access to this journal for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. John M. Oldham, MD, is the editor in chief and past president of the American Psychiatric Association.

About Wolters Kluwer Health Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer Health's market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2013 annual revenues of €3.6 billion ($4.7 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.

ELSE PRESS RELEASES FROM THIS DATE:

NASA sees powerful thunderstorms in Tropical Storm Matmo

2014-07-18

Strong thunderstorms reaching toward the top of the troposphere circled Tropical Storm Matmo's center and appeared in a band of thunderstorms on the storm's southwestern quadrant. Infrared imagery from NASA's Aqua satellite showed very cold temperatures that indicated the high cloud tops in the powerful storms. Tropical cyclones consist of hundreds of thunderstorms. When NASA's Aqua satellite flew over Tropical Storm Matmo on July 17 at 16:59 UTC (12:59 p.m. EDT) on July 17, the Atmospheric Infrared Sounder (AIRS) instrument obtained infrared data on the tropical cyclone. ...

High-dose fluticasone effective against eosinophilic esophagitis

2014-07-18

Results from a clinical trial show that high doses of the corticosteroid fluticasone propionate safely and effectively induce remission in many people with eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus characterized by high levels of white blood cells called eosinophils. However, some trial participants did not respond to fluticasone even after six months of high-dose treatments, providing evidence that certain people with EoE are steroid-resistant. By analyzing gene expression—the degree to which certain genes are turned on or off—in esophageal ...

Experts urge new discipline combining benefits of neuroscience and psychology treatments

2014-07-18

When a patient talks with a psychological therapist, what changes occur in the patient's brain that relieve mental disorders? UCLA psychology professor Michelle Craske says the honest answer is that we don't know. But, according to Craske and two colleagues, we need to find out. Mental health disorders — such as depression, schizophrenia, post-traumatic stress disorder, obsessive–compulsive disorder and eating disorders — affect 1 in 4 people worldwide. Psychological treatments "hold the strongest evidence base for addressing many such conditions," but they need improvement, ...

Tea Party support linked to educational segregation, new study shows

2014-07-18

In January of 2009, Barack Obama assumed the U.S. presidency in the midst of the most severe recession since the great depression of the 1930s. While many Americans hoped the new administration would take an active role in providing relief for those harmed by the economic collapse, a "Tea Party" movement emerged to oppose Obama's agenda. University of Notre Dame political sociologist Rory McVeigh, whose study, "Educational Segregation, Tea Party Organizations, and Battles over Distributive Justice," was recently published in the American Sociological Review, says "The ...

Yale researchers identify targets for immunotherapy in early-stage breast cancer

2014-07-18

July 17, 2014, New Haven, CT – Yale Cancer Center researchers used a new molecular analysis tool to accurately detect the level of an important target for immunotherapy in early-stage breast cancers. The diagnostic test, using RNAScope, measures the amount of PD-L1 (programmed death ligand 1) mRNA in routine formalin-fixed cancer tissues and is devoid of many of the technical issues that plague antibody-based detection methods that have yielded conflicting results in the past. PD-L1 is the target of several novel immune stimulatory therapies in clinical trials. The findings ...

Interleukin-10 aids survival of cells transplanted to repair cardiac tissues after MI

2014-07-18

Putnam Valley, NY. (July 18th 2014) – The long-term, positive benefits of transplanted allogenic (other-donated) smooth muscle cells (SMCs) to repair cardiac tissues after myocardial infarction (MI) have been enhanced by the addition of interleukin 10 (IL-10) to the transplanted cells, report researchers in Canada. Their study with rats modeled with MI has shown that SMCs modified with IL-10 - a small, anti-inflammatory protein - benefitted cell survival, improved heart function, and also provided protection against the host's rejection of the allogenic SMCs. The study ...

Highly charged ions

2014-07-18

The world is mostly neutral. That is, most of the atoms in our environment are electrically neutral. The number of electrons in the outer parts of atoms equals the number of protons at the centers of atoms. As one or more electrons are plucked away from the atoms, the remaining electrons feel a much stronger positive pull from the nucleus. This enhanced pull, causing the atoms to shrink in size, ensures that those electrons are less vulnerable to the distractions of their environment, making them potentially valuable for next-generation atomic clocks, for quantum information ...

Economic development not the only influence on personal car use, study finds

2014-07-18

Although countries with high levels of economic development generally have more personal automobile travel than less-affluent nations, income is not the only factor that determines a nation's demand for cars, according to a new study. Examining factors that may influence personal automobile use in developing nations, researchers found that government policies such as taxes that keep fuel costs high and the development of road systems can have important influence on levels of automobile travel. Shaping the personal use of automobiles is an important issue in developing ...

UM-led research team contributes to the management of South Florida coastal environments

2014-07-18

MIAMI – A Florida-based marine research team has developed a unique formal process and modeling framework to help manage South Florida's economically important coastal marine environments. The MARES project (Marine and Estuarine Goal Setting), led by the National Oceanic and Atmospheric Administration's (NOAA) Cooperative Institute for Marine and Atmospheric Studies (CIMAS) based at the University of Miami (UM) Rosenstiel School of Marine and Atmospheric Science, successfully integrated both ecosystem science and societal benefits into a marine ecosystem support tool to ...

Scientists find new clues to brain's wiring

2014-07-18

New research provides an intriguing glimpse into the processes that establish connections between nerve cells in the brain. These connections, or synapses, allow nerve cells to transmit and process information involved in thinking and moving the body. Reporting online in Neuron, researchers at Washington University School of Medicine in St. Louis have identified a group of proteins that program a common type of brain nerve cell to connect with another type of nerve cell in the brain. The finding is an important step forward in efforts to learn how the developing brain ...