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Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic
INTRODUCTION: Depression and anxiety are common. Rates are significantly higher in cystic fibrosis (CF), and impact health outcomes. Screening is recommended, but is difficult to implement/sustain annually in a busy CF centre. The aim was to develop an acceptable model for depression and anxiety scr...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098908/ https://www.ncbi.nlm.nih.gov/pubmed/33941540 http://dx.doi.org/10.1136/bmjoq-2020-001333 |
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author | Goetz, Danielle Marie Frederick, Carla Savant, Adrienne Cogswell, Alex Fries, Lynne Roach, Christine Shea, Nicole Borowitz, Drucy Smith, Beth |
author_facet | Goetz, Danielle Marie Frederick, Carla Savant, Adrienne Cogswell, Alex Fries, Lynne Roach, Christine Shea, Nicole Borowitz, Drucy Smith, Beth |
author_sort | Goetz, Danielle Marie |
collection | PubMed |
description | INTRODUCTION: Depression and anxiety are common. Rates are significantly higher in cystic fibrosis (CF), and impact health outcomes. Screening is recommended, but is difficult to implement/sustain annually in a busy CF centre. The aim was to develop an acceptable model for depression and anxiety screening in adolescents/adults with CF and their caregivers that could be sustained and shared. METHODS: Quality improvement methodology with plan-do-study-act cycles, flow diagrams, review of data monthly with our designated ‘Mental Health Team’ and caregiver satisfaction surveys, were used to begin screening in clinics and to improve the process. We then piloted our process at a larger paediatric CF centre. RESULTS: Prior to 2013, screening was not performed at our CF centre. After the first quarter of depression screening, 88% of adolescents and 69% of adults with CF were screened. The process was refined. By the second year, 99% of patients were screened. Anxiety screening began in year three; 97%–99% of patients were screened for both anxiety and depression in years 3–5. Annual caregiver screening rates were >95%. Screening was changed from Patient Health Questionnaire-2 (PHQ-2) to PHQ-9 due to better sensitivity in caregivers, and expanded to patients. Anxiety screening began in year 3 with the Generalised Anxiety Disorder-7 questionnaire. Patients and caregivers reported acceptance of screening. At the larger paediatric centre used as a pilot, 89.6% of patients were screened in year 1. Feedback included recommendations to improve tracking/follow-up of positive screens. CONCLUSIONS: Development and implementation of a stepwise process for depression and anxiety screening was successful in a paediatric/adult CF clinic, due to constant re-evaluation by an engaged team with feedback from patients via survey. A systematic approach at a busy CF centre can serve as a model to implement screening in a clinic. |
format | Online Article Text |
id | pubmed-8098908 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-80989082021-05-18 Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic Goetz, Danielle Marie Frederick, Carla Savant, Adrienne Cogswell, Alex Fries, Lynne Roach, Christine Shea, Nicole Borowitz, Drucy Smith, Beth BMJ Open Qual Quality Improvement Report INTRODUCTION: Depression and anxiety are common. Rates are significantly higher in cystic fibrosis (CF), and impact health outcomes. Screening is recommended, but is difficult to implement/sustain annually in a busy CF centre. The aim was to develop an acceptable model for depression and anxiety screening in adolescents/adults with CF and their caregivers that could be sustained and shared. METHODS: Quality improvement methodology with plan-do-study-act cycles, flow diagrams, review of data monthly with our designated ‘Mental Health Team’ and caregiver satisfaction surveys, were used to begin screening in clinics and to improve the process. We then piloted our process at a larger paediatric CF centre. RESULTS: Prior to 2013, screening was not performed at our CF centre. After the first quarter of depression screening, 88% of adolescents and 69% of adults with CF were screened. The process was refined. By the second year, 99% of patients were screened. Anxiety screening began in year three; 97%–99% of patients were screened for both anxiety and depression in years 3–5. Annual caregiver screening rates were >95%. Screening was changed from Patient Health Questionnaire-2 (PHQ-2) to PHQ-9 due to better sensitivity in caregivers, and expanded to patients. Anxiety screening began in year 3 with the Generalised Anxiety Disorder-7 questionnaire. Patients and caregivers reported acceptance of screening. At the larger paediatric centre used as a pilot, 89.6% of patients were screened in year 1. Feedback included recommendations to improve tracking/follow-up of positive screens. CONCLUSIONS: Development and implementation of a stepwise process for depression and anxiety screening was successful in a paediatric/adult CF clinic, due to constant re-evaluation by an engaged team with feedback from patients via survey. A systematic approach at a busy CF centre can serve as a model to implement screening in a clinic. BMJ Publishing Group 2021-05-03 /pmc/articles/PMC8098908/ /pubmed/33941540 http://dx.doi.org/10.1136/bmjoq-2020-001333 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Quality Improvement Report Goetz, Danielle Marie Frederick, Carla Savant, Adrienne Cogswell, Alex Fries, Lynne Roach, Christine Shea, Nicole Borowitz, Drucy Smith, Beth Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title | Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title_full | Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title_fullStr | Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title_full_unstemmed | Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title_short | Systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
title_sort | systematic depression and anxiety screening for patients and caregivers: implementation and process improvement in a cystic fibrosis clinic |
topic | Quality Improvement Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098908/ https://www.ncbi.nlm.nih.gov/pubmed/33941540 http://dx.doi.org/10.1136/bmjoq-2020-001333 |
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