Scenario for Method 4: Team-based Quality Improvement
Example: Limited counseling accessed by patients with depression
Team Context: A social worker was recently added to the healthcare team but was not seeing many patients with depression. During a recent visit, a patient mentioned that they were unaware that counselling could be offered through the clinic and that they could self-refer to the social worker on the team. Authors of a 2011 Cochrane review demonstrated that counselling patients with mental health and psychosocial problems in primary care was associated with significantly greater clinical effectiveness in short‐term mental health outcomes compared to usual care.[i] Cognitive behavioral therapy, part of the training of this social worker, was shown to be as effective as other psychotherapies or pharmacotherapy for adults with depression in another meta-analysis; in this study combined treatment was significantly more effective than pharmacotherapy alone.[ii]
PCM Context: A query of the electronic health record (EHR) revealed that while half of adult patients diagnosed with depression were currently recorded as taking medication, less than one quarter of those charts had recorded that patients received any counseling, and less than 20% were regularly completing a patient-reported measure for depression (i.e., PHQ-9).
Evaluation: The clinical team wanted to know if their adult patients with depression would be receptive to counseling by the new social worker, if they had received prior virtual or in-person counseling and what their experiences had been, and if they would be amenable to virtual counseling. The practice began by using the portal to send a letter to their patients with depression or anxiety, introducing the social worker, how to contact her for counseling, and inviting patients to complete a questionnaire about their experiences with counseling. After two weeks, there were 40 responses to the questionnaire and the office assistant created a summary of these responses.
Knowledge Mobilization: The team met to review these data and it appeared that most patients had been unable to access counseling and the majority (70%) would be interested in pursuing it. There had been some success with virtual counseling and many patients (58%) were amenable to trying this format. The social worker had 3 new patients contact her to arrange counseling in response to the letter, and had set up PHQ-9s to be sent two days before to each counselling appointment. The team decided to reach out to the interested patients from the survey and in two months reassess through an EHR query, social worker patient schedule and pre/post comparison of PHQ-9 responses.
[i] Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD001025.
[ii] Cuijpers P, Berking M, Andersson G, et al. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry. 2013 Jul;58(7):376-85.