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Depression Screening and Behavioral Health Integration in Musculoskeletal Trauma Care
Journal of Orthopaedic Trauma ( IF 2.3 ) Pub Date : 2022-09-01 , DOI: 10.1097/bot.0000000000002361
Eric Secrist 1 , Meghan K Wally 1 , Ziqing Yu 1 , Manuel Castro 2 , Rachel B Seymour 1 , Joseph R Hsu 1 ,
Affiliation  

Objectives: 

To report our experiences in implementing a behavioral health integration pathway, including a validated depression screening and referral to care.

Design: 

Retrospective case series.

Setting: 

Single surgeon's musculoskeletal trauma outpatient practice during calendar year 2019.

Patients: 

All patients presenting to the practice during 2019 were included (n = 573).

Intervention: 

We piloted the usage of Patient Health Questionnaire (PHQ)-2 and PHQ-9 screening. An evidence-based, real-time treatment protocol embedded in the electronic health record was triggered when a patient screened positive for depression including an automated behavioral health integration pathway.

Main Outcome Measurements: 

The percentage of patients screened, the results of the PHQ screening, and the number of patients referred and enrolled in behavioral health programs were collected.

Results: 

Of the 573 patients, 476 (83%) received the PHQ-2 screening, 80 (14%) had a current screening on file (within 1 year), and 17 (3.0%) were not screened. One hundred seventy-two patients (36%) had a PHQ-2 score of 2 or greater and completed the PHQ-9; of them, 60 (35% of patients screened with full PHQ-9, 13% of patients screened) screened positive for symptoms of moderate depression (PHQ-9 score ≥10), and 19 (4.0%) reported passive suicidal ideation (PHQ-9 item 9). Fifty of these patients were referred to behavioral health through the pathway, and 8 patients enrolled in the program. Ten patients were not referred because of a technical error that was quickly resolved. Patients reporting suicidal ideation were managed with psychiatric crisis resources including immediate virtual consult in the examination room.

Conclusions: 

This case series demonstrates the feasibility of screening patients for depressive symptoms and making necessary referrals to behavioral health in outpatient musculoskeletal trauma care. We identified 50 patients with depression and appropriately triaged them for further care in our community.



中文翻译:

肌肉骨骼创伤护理中的抑郁症筛查和行为健康整合

目标: 

报告我们在实施行为健康整合途径方面的经验,包括经过验证的抑郁症筛查和转诊护理。

设计: 

回顾性案例系列。

环境: 

2019 日历年单人外科医生的肌肉骨骼创伤门诊实践。

患者: 

2019 年期间就诊的所有患者均被纳入其中 (n = 573)。

干涉: 

我们试行使用患者健康问卷 (PHQ)-2 和 PHQ-9筛查。当患者筛查出抑郁症呈阳性时,就会触发嵌入电子健康记录中的基于证据的实时治疗方案,其中包括自动行为健康整合途径。

主要结果测量: 

收集了筛查患者的百分比、PHQ筛查结果以及转诊和参加行为健康计划的患者数量。

结果: 

在 573 名患者中,476 名 (83%) 接受了 PHQ-2筛查,80 名 (14%) 已记录当前筛查(1 年内),17 名 (3.0%) 未接受筛查。172 名患者 (36%) 的 PHQ-2 评分为 2 或更高,并完成了 PHQ-9;其中,60 名(35% 接受全面 PHQ-9 筛查的患者,13% 接受筛查的患者)中度抑郁症状筛查呈阳性(PHQ-9 评分≥10),19 名(4.0%)报告有被动自杀意念(PHQ -9 第 9 项)。其中 50 名患者通过该途径转诊至行为健康科,8 名患者参加了该计划。由于技术错误,十名患者没有被转诊,但很快就得到了解决。报告自杀意念的患者通过精神危机资源进行管理,包括在检查室立即进行虚拟咨询。

结论: 

该病例系列证明了在门诊肌肉骨骼创伤护理中筛查患者抑郁症状并进行必要的行为健康转诊的可行性。我们确定了 50 名抑郁症患者,并对他们进行了适当分类,以便在我们的社区中接受进一步护理。

更新日期:2022-08-19
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