Depression DEP1/DEP2

[SteveR]

Hi all, I wonder if anybody has any thoughts to share about these items on the QoF submissions.

How are your staff dealing with it?

We are still discussing it ourselves but essentially, we are likely to be asking the initial 2 questions and then, if either of the 2 questions are answered in the positive, we are asking them to complete a second questionnaire - we are looking at using the free questionnaire located here:


Patient Health Questionnaire (PHQ-9)
http://www.depression-primarycare.or...questionnaire/

This one is free but there are 2 others which are paid for:

Hospital Anxiety and Depression Scale (HADS)
http://www.nfer-nelson.co.uk/catalog...tid=98&id=1125

Beck Depression Inventory Second Edition (BDI-II)
http://harcourtassessment.com/cgibin/
MsmGo.exe?grab_id=112&page_id=9707008&query=beck%2 A&hiword=beck%2A+

Which questionaire are folks using?

Depending on the results of the second questionnaire actions are taken - on a patient by patient basis.

I'd be grateful for anybodies thoughts.

many thanks

Steve

[Jackie Jackson]

Hi Steve.


Our Practice is part of theNPDT Mental Health Collobrative ON Mental Health and after asking the two questions to chronic disease patients depending on the answer the PHQ9 is used.

[SteveR]

Thanks for the reply Jackie. Can I ask you to describe how your clinicians manage this in a bit more detail. Where do patients fill in the PHQ9 (if needed) and who asseses the score and so forth.

I would just like to be able to advise 'best practice' if I can and do it in the most efficient way possible.

Many many thanks
Steve

[gary]

Steve, have a look at the medical algorithms site www.medal.org you have to register and then you can download their tests, or use their online forms. Their PHQ9 is uploaded here in excel format.
How to manage clinically?- perhaps you can get the pt to fill out a paper version in the consultation then let the Dr enter the results onto the excel form or use the online one, for instant results. Alternatively, once the online form has been brought up on the Drs browser, get the patient to tell the dr the results as he reads them the question, and fill it out online!
The PHQ9 test is in the psychiatry section on the medal site

[SteveR]

Thanks for the info Gary, an Excel version is going to be pretty handy. I should have thought of that and made one myself!

Steve

[des.mccarthy]

Shame you are not using FrontDesk appointment system, now with Contract+ built in, as this gives you a depression questionnaire which automatically inserts the answers into the notes with Read Codes which are reported by QMAS. Strongly recommend you exploring it as a product see http://www.fdfw.co.uk/

Des

[SteveR]

Thanks for the info Des, will look into it - although we have just got used to SystmOne I am not sure a change here would go down too well

Steve

[DOLINA]

With regards to the first 2 questions this is being attached to prescriptions and if need be we will be following up with postal questionnaires. On receiving feedback we will be using the PHQ-9 available in several languages from www.cgrg.org.uk.

[Rachael]

We have altered the standard EMIS template for depression and added a link to a version of the PHq-9 questions. The GP talks to the patient and includes the questions in his consultation. He then enters the score on the template.

It seems to work OK

Rachael

[docarhamilton]

Have any of the clinicians any thoughts on how useful (or not!) they find this process of searching for patients with depression? Speaking with colleagues, opinions seem to vary from those who think it's a total waste of time to those who've managed to pick up patients with unsuspected depressive symptoms. That then begs the question of what do you do with patients who are so depressed you need a questionnaire to figure out that they are! Is there justification for giving them anti-depressants or sending them for counselling?
Where is the evidence base for this sort of thing anyway? It used to be that screening programmes had to fulfil strict criteria to do with sensitivity, specificity, usefulness, clinical importance, treatability etc. etc. before being adopted. A whole load of these new QOF points are being introduced, with more to come, with little evidence base to show that they are in any way clinically useful.
Andrew.