New Electronic Tool Flags Serious Depression

No treatments seemed to work for Eric*, a 38-year old diabetic. While his care team at Bellevue worked diligently to develop an action plan for the patient, his condition was not improving.

“I tried to take care of his diabetes, but he wasn’t taking his medication or following up with his appointments,” said Damara Gutnick, M.D., primary care physician.

But an assessment by Dr. Gutnick led Eric to treatment for clinical depression. Eric was soon able to participate more actively in his care and get his diabetes under control.

Eric is one of thousands of diabetics who according to national research findings suffer from depression at twice the rate of those without diabetes. That's why depression screening is now becoming part of standard treatment for more than 50,000 diabetics being cared for and monitored by the city's public hospitals.

A widely used depression screening tool, Patient Health Questionnaire 9 (PHQ 9), has been added directly into each diabetic patient's electronic medical record, prompting doctors and other members of the care team to ask the patient several key questions. The tool then generates a score based on a patient’s response and provides the doctor with a severity assessment and treatment options.

HHC plans to expand depression screening to other patients with chronic conditions such as congestive heart failure and eventually offer the screening as part of routine medical care for all patients. After all, depression and other mental illnesses affect 16 percent of all Americans at some time and an estimated 13 percent of all New York City adults.

As part of the program expansion, primary care physicians at HHC are now being trained to treat mild and moderate depression, so diagnosis can be followed up with prompt treatment. Social workers and psychiatrists are increasingly part of the primary care team on site, cutting wait times and no-shows for appointments.

“When primary care doctors can address depression, patients get the treatment quicker and there’s no stigma associated with seeking care at a separate mental health clinic,” said Dr. Evelyn Opoku, Medical Director of Cumberland Diagnostic and Treatment Center.

* Name has been changed