Abstract
BackgroundDespite the growing interest in assessing the quality of care for depression, there is little evidence to support measurement of the quality of primary care for depression. This study identified evidence-based quality indicators for monitoring, evaluating and improving the quality of care for depression in primary care settings.MethodsOvid MEDLINE and Ovid PsycINFO databases, and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (1) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (2) quality indicators were applicable to assessment of care for adults with depression in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, which contains four domains and 20 items. A narrative synthesis was used to combine the indicators within themes. Quality indicators applicable to care for adults with depression in primary care settings were extracted using a structured form. The extracted quality indicators were categorized according to Donabedian’s ‘structure-process-outcome’ framework.ResultsThe search revealed 3838 studies. Four additional publications were identified through grey literature searching. Thirty-nine articles were reviewed in detail and seven met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and usage of indicators in practice were scarcely described. A total of 53 quality indicators were identified from the included studies, many of which overlap conceptually or in content: 15 structure, 33 process and four outcome indicators. This study identified quality indicators for evaluating primary care for depression among adult patients.ConclusionsThe identified set of indicators address multiple dimensions of depression care and provide an excellent starting point for further development and use in primary care settings.
Highlights
Despite the growing interest in assessing the quality of care for depression, there is little evidence to support measurement of the quality of primary care for depression
We looked for existing indicators at websites of major organizations involved in quality measurement and reporting of indicators for assessing the quality of depression care, including the RAND Health Corporation/Assessing Care of Vulnerable Elders (ACOVE), Canadian Mental Health Association and the online inventory maintained by the Center for Quality Assessment in Mental Health
Four additional publications were identified through grey literature searching
Summary
Despite the growing interest in assessing the quality of care for depression, there is little evidence to support measurement of the quality of primary care for depression. This study identified evidence-based quality indicators for monitoring, evaluating and improving the quality of care for depression in primary care settings. The 12-month prevalence of depression is 4.7%, with a lifetime prevalence of up to 16.6% in adults aged 18 years and older [6]. Previous research showed that the rate of depression was higher among older adults within hospitals (21%) [1] and long-term care facilities (14%) [7]. Poor levels of detection, treatment and monitoring of depression have been highlighted in primary care settings [14].
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