The Use of Electronic Health Record Tools to Improve Evidence-Based Treatment of Adolescent Depression in Primary Care
| Autor: | Harlan McCaffery, Teryn Bruni, Abigail Caserta, Kelly A. Orringer, Joyce Y. Lee, Joanna Quigley, Alexandros Maragakis, Leah LaLonde, Shawna N. Smith, Blake M. Lancaster, Amy M. Kilbourne |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Evidence-based practice Adolescent Health information technology education Psychological intervention Documentation 03 medical and health sciences 0302 clinical medicine 030225 pediatrics medicine Electronic Health Records Humans 030212 general & internal medicine Depression (differential diagnoses) Retrospective Studies Protocol (science) Primary Health Care Depression business.industry Behavioral activation Patient Health Questionnaire Family medicine Pediatrics Perinatology and Child Health business |
| Zdroj: | Academic Pediatrics. 21:1195-1202 |
| ISSN: | 1876-2859 |
| DOI: | 10.1016/j.acap.2021.05.022 |
| Popis: | Objective The aim of the current study was to evaluate primary care pediatrician (PCP) adoption of an electronic health record (EHR) documentation tool and their delivery of a behavioral activation (BA) intervention within their routine practice with adolescents who screened positive for depression. Methods We used the RE-AIM framework to describe PCP adoption and implementation of EHR documentation tools and brief evidence-based protocols. Utilization was assessed using a customized toolbar (ie, actions toolbar) via retrospective chart review. A pre-post design was used to measure changes in PCP-reported knowledge, comfort, and feasibility managing depression before and after they were trained. A mixed-effects logistic regression model was used to analyze associations of resource utilization with depression severity. Results PCPs used the actions toolbar to document responses to elevated Patient Health Questionnaire (PHQ-9) scores for 29.80% of encounters. The PCPs utilized the BA protocol for 10.5% of encounters with elevated PHQ-9 scores. Higher depression severity categories were associated with significantly higher odds of utilization relative to mild severity. The training was rated highly acceptable and PCPs reported significant post-training increases in comfort and feasibility. Conclusion This is the first study of its kind to implement and evaluate PCP utilization of an EHR documentation tool aimed to improve delivery of an evidence-based intervention for adolescent depression. Teaching PCPs to implement brief interventions has potential to increase access to evidence-based care; however, large-scale practice change requires an effective implementation strategy that does not increase provider burden and is fully integrated into physician documentation and workflow. |
| Databáze: | OpenAIRE |
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