PMH3 - Patient and Provider Characteristics Associated with PHQ-9 Administration and Outcomes Assessment in Routine Clinical Practice: Findings from the OM1 Data Cloud

Abstract

Depression is a debilitating condition that is often comorbid with other chronic illnesses. Primary care is usually the setting for initial screening and routine management of depression patients. The Patient Health Questionnaire (PHQ-9) is a validated instrument for both screening and tracking outcomes in major depression. We examined PHQ-9 usage in routine clinical practice. The OM1 Data Cloud hosts extensively linked clinical and administrative data on tens of millions of patients in the United States. Patients with Electronic Medical Record (EMR) data from 2015-2017 were used as a sample to evaluate the level of recorded use of PHQ-9 in structured data within an EMR. Of the 23 million patients with outpatient encounters between 2015 and 2017, 184,009 (0.8%) were evaluated for depression using the PHQ-9 and their results were recorded in their EMR. Of the individuals evaluated, 59% were 18-64 years old and the majority were female (58%) and Caucasian (82%). The top provider specialties associated with PHQ-9 administration were Internal Medicine, Psychiatry, Family Medicine, Emergency Medicine, Pediatrics and Obstetrics-Gynecology. Provider types included physician, social worker, mental health counselor, psychologist and nurse practitioner. Patients assessed with PHQ-9 were likely to have hypertension, hyperlipidemia, major depressive disorder, diabetes mellitus or anxiety disorder conditions. Nearly 64,600 patients with a PHQ-9 measurement had a diagnosis of major depression, of whom 66% were on an antidepressant. In this group of treated patients, 30% had a recorded repeat measure within the time period. The recorded use of PHQ-9 to screen for and track treatment outcomes in depression patients was relatively low in this large representative sample. Despite guidelines and state quality reporting standards recommending depression screening in primary care settings and recent standardization on the PHQ-9 for outcomes measurement, documentation in EMR in routine clinical practice is limited.