Man it's been a long time.  Life gets that way I guess.

I wanted to share a little process we're working on.

We all know that roughly 25% of the patients who visit a primary care office in any given year are depressed at one of their visits.  I work in a Federally Qualified Health Center (FQHC) serving mostly the un- and under-insured and our rates are probably higher than that.  

We also know that depression is vastly under-diagnosed in primary care.  There's a PHQ-2 screening tool for depression and then a PHQ-9 diagnosis and monitoring tool for depression.  Basically, if either of the first two questions are positive, you ask the next seven questions.  If the PHQ-2 is positive, you just added 9-10 minutes to the visit.  Those of us who admit it will tell you that adding 9-10 minutes to a 15-20 minute prohibits using the PHQ2.

Then my medical assistant Twyla Womack took over.  At first, she gave the PHQ-9 form to the patients and asked them to fill it out while they wait for me.  Who cares if they fill out all 9 questions when the first 2 are negative?  She would then leave the form for me to see when I went into the room.  Later, she would enter the results into the EMR.  She easily saved me 8 minutes for every positive PHQ-9.  After a while, she noticed that some patients skipped some of the questions and so she wasn't sure people fully understood the questions.  At that point, she started asking the questions and recording the patients' answers directly into the EMR.

From October 1, 2012 through January 31, 2013, even though I was only seeing patients 16 hours per week, Twyla completed and documented 240 PHQ-9s in our EMR, plus all the negative PHQ-2s!  

We need to crunch more data to see the longitudinal change in PHQ-9 scores to make sure we're having a clinical effect.  However, you can only treat what you can diagnose.