Depression screening in uninsured patients in a primary care setting

Abstract

There is a strong correlation between chronic disease and depression; however, screening patients for depression is not typical in the primary care setting due to factors such as time constraints and the provider's ability to diagnose and manage depression. This study sought to: (1) determine the prevalence of depression in uninsured or underinsured patients with chronic diseases using a screening instrument validated for use in the primary care setting, (2) provide a referral to the patient's primary care provider (PCP) for depression management prior to disease management as needed, and (3) enroll patients for chronic disease management services. The study utilized a cross-sectional design consisting of a self-administered survey and medical record review after physician and nursing appointments. Patients completed the Beck Depression Inventory for Primary Care (BDI-PC) upon program enrollment. Patients that screened positively for depression were referred to the PCP for follow-up services prior to entry into one of the disease management programs. After PCP appointments took place, medical records were reviewed to obtain medical and depression diagnoses, along with mediation recommendations. Forty-one patients were enrolled in the clinic program and completed the depression screening. Eight patients were found to have mild depression and two patients had moderate depression as determined by the BDI-PC, which accounted for 24% of the clinic patients. Four of the patients with mild depression and both patients with moderate depression initiated antidepressant therapy. Additionally, three patients with minimal scores on the screening began medication therapy based on symptoms reported to the PCP. The results of this study suggest that it is feasible to incorporate a depression-screening tool in a primary care setting with further evaluation and follow-up by primary care providers.