Depression screening to improve early detection, referral, and treatment of depression in patients with diabetes

Comorbid depression is common among adults with diabetes and is associated with negative impacts on quality of life, health outcomes, and mortality rates. As of 2015, it was estimated that 415 million people were living with diabetes in the United States, and of those affected, 20 to 25 percent have some degree of depression. Evidence-based guidelines recommend routine depression screening. This appears to decrease negative health outcomes and may be a cost-effective way to reduce the risk of adverse outcomes. Despite recommendations, depression screening in patients with diabetes is not consistent. This is true for patients at the study clinic who were not being routinely screened for depression. To address this gap, we developed a depression screening protocol that incorporated a brief, validated depression screening tool into the patient's electronic health records. The protocol outlined the criteria for screening adult patients for depression using the Patient Health Questionnaire (PHQ). In this project, outcomes of implementation of the PHQ in the outpatient Endocrine clinic were evaluated. Included in this 4-week retrospective review were 54 patients who presented to the clinic for routine scheduled appointments. Of those, 40 patients (78%) were administered the PHQ and 14 (22%) were not screened. Results showed that screening in this clinic significantly improved, but rate of referrals was not impacted since none of the 40 screens resulted in a positive screen. This project addresses the healthcare needs of patients with diabetes and depression with emphasis on improving care, safety, and outcomes while reducing healthcare expenditures.