Objective

The aim of the current study was to evaluate primary care pediatrician (PCP) adoption of an electronic health record (EHR) documentation tool and their delivery of a behavioral activation (BA) intervention within their routine practice with adolescents who screened positive for depression.

Methods

We used the RE-AIM framework to describe PCP adoption and implementation of EHR documentation tools and brief evidence-based protocols. Utilization was assessed using a customized toolbar (ie, actions toolbar) via retrospective chart review. A pre-post design was used to measure changes in PCP-reported knowledge, comfort, and feasibility managing depression before and after they were trained. A mixed-effects logistic regression model was used to analyze associations of resource utilization with depression severity.

Results

PCPs used the actions toolbar to document responses to elevated Patient Health Questionnaire (PHQ-9) scores for 29.80% of encounters. The PCPs utilized the BA protocol for 10.5% of encounters with elevated PHQ-9 scores. Higher depression severity categories were associated with significantly higher odds of utilization relative to mild severity. The training was rated highly acceptable and PCPs reported significant post-training increases in comfort and feasibility.

Conclusion

This is the first study of its kind to implement and evaluate PCP utilization of an EHR documentation tool aimed to improve delivery of an evidence-based intervention for adolescent depression. Teaching PCPs to implement brief interventions has potential to increase access to evidence-based care; however, large-scale practice change requires an effective implementation strategy that does not increase provider burden and is fully integrated into physician documentation and workflow.

中文翻译：

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使用电子健康记录工具改善初级保健中青少年抑郁症的循证治疗

客观的

本研究的目的是评估初级保健儿科医生 (PCP) 对电子健康记录 (EHR) 文档工具的采用以及他们在对抑郁症筛查呈阳性的青少年的日常实践中实施行为激活 (BA) 干预的情况。

方法

我们使用 RE-AIM 框架来描述 PCP 对 EHR 文档工具和简要循证协议的采用和实施。使用自定义工具栏（即操作工具栏）通过回顾性图表审查评估利用率。使用前后设计来衡量 PCP 报告的知识、舒适度和在他们接受培训之前和之后管理抑郁症的可行性的变化。混合效应逻辑回归模型用于分析资源利用与抑郁严重程度的关联。

结果

PCP 使用操作工具栏来记录对 29.80% 的会诊患者健康问卷 (PHQ-9) 评分升高的反应。PCP 使用 BA 协议处理 10.5% 的 PHQ-9 分数升高。相对于轻度严重程度，较高的抑郁严重程度类别与显着较高的利用几率相关。培训被评为高度可接受，PCP 报告培训后舒适度和可行性显着提高。

结论

这是同类研究中首次实施和评估 PCP 对 EHR 文档工具的利用，旨在改善青少年抑郁症循证干预措施的实施。教导 PCP 实施简短的干预措施有可能增加获得循证护理的机会；然而，大规模的实践变革需要一个有效的实施策略，既不会增加提供者的负担，又要完全融入医生文档和工作流程中。