Enhancements to electronic health records can improve the diagnosis and management of depression
Health Information Technology
Most treatment for depression takes place at the primary care level. The level of depression severity must be determined, including assessment for suicide risk, in order to provide effective treatment. Including prescription fill data and answers from a patient questionnaire in electronic health records (EHRs) improves the identification of depression severity, treatment response, and suicidality, according to a recent study.
Researchers collected data on 117,878 patients from 14 practices participating in the Distributed Ambulatory Research in Therapeutics Network study to examine how EHR data can be used to determine the level of depression severity and improve its diagnosis and management. The study linked data from EHRs at 25 organizations comprised of 1,700 clinicians and more than 3 million patients. Practices were prompted by the EHR to use a 9-item short patient questionnaire to obtain scores on the severity of depression and its impact on functional impairment. In addition, prescription fulfillment data were used to find out which patients filled an antidepressant prescription. A total of 81,028 episodes of depression were identified in 61,464 patients. There was substantial variation found in the severity of illness and suicidality at baseline.
The questionnaire identified 25 percent to 30 percent of patients who had some thoughts of suicide. Suicidality was found to have a direct correlation with the severity of depression. By adding prescription fulfillment data to severity assessments, the researchers were able to determine the levels of medication adherence and how changes in treatment affected the level of suicidality. Supplementing EHR data with prescription fulfillment data and depression questionnaire data created a measurement-based care environment for the treatment of depression. The study was supported by AHRQ (Contract No. 290-05-0037).
See "Enhancing electronic health record measurement of depression severity and suicide ideation: A distributed ambulatory research in therapeutics network (DARTNet) study," by Robert J. Valuck, Ph.D., R.Ph., Heather D. Anderson, Ph.D., Anne M. Libby, Ph.D., and others in the September-October 2012 Journal of the American Board of Family Medicine 25(5), pp. 582-593.