Measuring adherence to depression treatment guidelines in a VA primary care clinic

Steven K. Dobscha, Martha S. Gerrity, Kathryn Corson, Alison Bahr, Nancy M. Cuilwik

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

The primary objectives of this pilot study were to develop a measure of adherence for depression practice guidelines and to assess the degree to which providers and patients adhere to guidelines in a VA primary care setting. The Depression Guideline Measure (DGM) is based on three national guidelines. The DGM was used to review medical records of 111 patients with Patient Health Questionnaire (PHQ) scores ≥10. Interrater reliability for 15 of 19 DGM checklist items was excellent (κ > 0.75). There was a broad range of adherence to guideline criteria: only 13.5% of patients were contacted for follow-up within 2 weeks, while 100% of providers documented follow-up plans. Forty percent of patients saw mental health providers, and 63% were prescribed antidepressants. A secondary objective of the study was to explore the relationship between guideline adherence and changes in PHQ scores. Among 51 patients who completed follow-up PHQs, no associations were detected. The results suggest that the DGM shows promise as a reliable measure of guideline adherence and that guideline criteria are frequently not met in busy primary care clinics. More research is needed to determine the validity of the DGM and the impact of guideline adherence on depression outcomes.

Original languageEnglish (US)
Pages (from-to)230-237
Number of pages8
JournalGeneral Hospital Psychiatry
Volume25
Issue number4
DOIs
StatePublished - 2003
Externally publishedYes

Keywords

  • Depression
  • Guideline adherence
  • Primary Health Care

ASJC Scopus subject areas

  • Psychiatry and Mental health

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