How to Conduct an Effective PHQ2 & PHQ9 … to Conduct an Effective PHQ2 & PHQ9 Depression Screening Algorithm & Protocol for Treatment of Depression Richard Maye, MBA & Dr. John Mason

How to Conduct an Effective PHQ2 & PHQ9

Depression Screening

Algorithm & Protocol for Treatment of Depression

Richard Maye, MBA & Dr. John Mason

May 31, 2017

Disclaimer

Medical Advantage Group would like to disclose that no one

is in a position to control or influence the content of this

activity has reported relevant financial relationships with

commercial interests.

The information and guidelines contained in this activity are

generalized and may not apply to all practice situations.

Medical Advantage Group recommends that legal advice be

obtained from a qualified attorney for specific application to

your practice. The information is intended for educational

purposes and should be used as a reference guide only.

2Value Driven. Health Care. Solutions.

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Objectives

Recognize the need to make depression screening an

expected office practice in primary care

Understand the screening tools

Learn how to utilize the results to direct the patient

toward the proper care pathway

Become acquainted with the treatment approaches for

depression


Rate of Depression Screening in Primary Care

In 2012-2013 only 4.2%

of adults were screened

for depression (1)

Value Driven. Health Care. Solutions. 5

4.2% 47%

Of the primary care

visits that screened for

depression, 47%

resulted in a new

depression diagnosis (1)

Missed Opportunities

This suggests that screening may be prompted

by a suspicion of depression, causing a

significant number of patients to be missed that

do NOT display or disclose symptoms(1)



African-American

patients were half

as likely to be

screened as white

patients

Elderly patients

were half as likely

to be screened as

middle aged

patients

Prevalence of

major

depression in

adolescents

rose 37% from

2005 to 2014(2)

Patients with

chronic conditions

were more likely

to be screened(1)

50%LESS

37%CHRONIC+

Rate of Depression Screening in Primary Care

(cont.)

50%LESS

Why?

Asking behavioral health questions to patients may not

come naturally to staff trained for the primary care

environment

Mental health resources may be limited

Screening could be viewed as additional work that

takes too much time

If screening results are significant, what now?

The significant relationship between mental and

physical health is NOT given the weight it should be


Strategy for Improvement

Collect and analyze your existing data

If you use an EMR for patients to electronically register

for an appointment, include the screening tools in that

process

Include the screening tools in new patient packets

along with basic educational materials that identify

symptoms

Train all staff on the relationship between mental and

physical health

Train all staff to recognize common signs of depression

and anxiety


ASSESSING DEPRESSION


The Criteria for Making a Referral to Behavioral Health

PHQ9 Algorithm #1

Value Driven. Health Care. Solutions.

A quick and easy instrument for screening, diagnosing,

and monitoring the severity of depression

Self-administered test, so very little additional time

spent with patient

Tool rates the frequency of symptoms which factors

into the scoring severity index

Scoring is quick and can be done by anyone

Instrument can be used as a post and pre-treatment

measure to measure progress

Results are easy to understand

PHQ9 Algorithm #1 cont.

Value Driven. Health Care. Solutions.

Consists of 9 questions, scored on a scale of 1 to 3

– 0 = none

– 1 = several days

– 2 = more than half the days

– 3 = nearly every day

Time frame of past 2 weeks

Step 1 – questions 1 and 2, one or both endorsed as 2 or 3

Step 2 – add points for each column

Step 3 – review severity score per the table

10 to 20 points suggest depression at various severities

PHQ2 can be used as a preliminary test, but has limited value

since it only contains 2 questions

PHQ9 provides more robust assessment

PHQ9 Algorithm #2

Other factors to consider when identifying depression

should be taken into consideration, and these make up

Algorithm 2

All 6 items are rated 0 through 3, with 3 being the most

critical

– Add these numbers to the PHQ9 total – if higher than 14,

a behavioral health referral should be made


PHQ9 Algorithm #2 cont.

Administering psychotropic medication and no

progress – 3

Clinical presentation – how does the patient look and

behave in a clinical setting? – 0-3

Suicidal ideations – requires immediate referral

Past treatment, hospitalizations, severity based on

number of times and recent treatments – 0-3

How long in therapy? Longer = more critical. – 0-3

Is depression situational in nature? i.e. loss of relative,

trauma, divorce, lost job, etc. – 0-3


Therapy Techniques

Many different therapy approaches in the treatment of

depression

As with treating all mental health issues, the use of

research-supported approaches are the most desired

A good therapist is eclectic – that is, a pro who can shift

approaches to fit the client’s needs

In today’s clinical practice, cognitively based

approaches are the first choice.1. Rational Emotive Therapy – involves challenging irrational beliefs and

the development of rational beliefs to deal with mental health problems

2. Cognitive Behavioral Therapy – involves restructuring thought

processes and beliefs to gain a more rational approach to problem

solving


Summary

Prevalence of depression is well documented and

requires attention by the primary care providers

Mental illness begins at an early age

Early intervention can improve the mental and physical

health of patients


QUESTIONS


Contact

Richard [email protected]


References

1. Open Minds Article; “What’s With the 4.2%?”, March

24, 2017. Citation: “National Rates and Patterns of

Depression Screening in Primary Care: Results From

2012 and 2013, by Ayse Akincigil, Ph.D. and Elizabeth

B. Mathews, M.S.W. ; from the National Ambulatory

Medicare Care Survey of 2102-2013

2. Open Minds Article: “Prevalence of Major Depression

In Adolescents Rises 37% From 2005 To 2014:

Citation: “National Trends in the Prevalence and

Treatment in Adolescents and Young Adults” by Ramin

Mojtabai, Mark Olfson and Beth Han.


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Documents

How to Conduct an Effective PHQ2 & PHQ9 … to Conduct an Effective PHQ2 & PHQ9 Depression Screening Algorithm & Protocol for Treatment of Depression Richard Maye, MBA & Dr. John Mason