Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital.
Letha M Joseph, Diane C Berry, Ann Jessup and 3 others
PMID 30534392WHAT IT FOUND
Screening hospitalized veterans with type 2 diabetes for depression was feasible; five completers had lower scores at 12 weeks.
The study had no control group and several components were given together, so no single component can be credited.
Key findings
01Of 30 patients approached, 21 (70%) consented and completed screening; 7 screened positive, 2 died, and 5 completed follow-up.
02For the five completers, mean PHQ-9 scores were 16 at baseline, 8 at 8 weeks, and 4 at 12 weeks, with all five showing clinical improvement.
03The five completers received screening feedback, education materials, electronic medical record notification, provider discussion of options and a management plan, antidepressants for four, psychotherapy for one, mental health referrals, discharge referral to primary care mental health integration, and a 30-day follow-up appointment; providers had also received education and pocket cards.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only five participants completed follow-up, and two of the seven enrolled died, so the results are descriptive and unstable. The study had no control group and no power analysis, and planned paired t tests were not reported because of the low number. The study was short and did not measure the effect of depression management on glycaemic control. The sample was veterans admitted to one hospitalist service, so applicability to all people with diabetes is questionable. Patients received screening feedback, education materials, electronic record notification, provider discussion and plan, antidepressants, psychotherapy for one, referrals, and discharge follow-up together, so no single component can be credited. The study aimed to evaluate 30-day readmission, but the reported healthcare-use results covered emergency department visits and hospitalizations during the follow-up period rather than a tested readmission outcome. Only nine of 13 providers answered the provider survey. Nine of 30 approached patients declined, so results may not apply to all patients.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that electronic depression screening or antidepressant treatment caused the improved scores. The study had five completers, no control group, no statistical comparison, and patients received screening feedback, education materials, electronic record notification, provider discussion and plan, antidepressants, psychotherapy for one, referrals, and discharge follow-up together; providers also received education and pocket cards.