Table 2 Themes and ideas from the panel discussion
Barriers | Themes | Frequency | Representative Quotes |
Medical assistant administration of the PHQ-2 | Medical assistant training is key | 4 | “Medical Assistants may not be appropriate to administer the PHQ, because they have very limited training. In other places, nurses do the screening and they’re much better trained, and the results are more accurate. It’s a much more costly option, but overall (not just for depression) it’s led to much better outcomes. Penn has decided to use medical assistants for vitals and you get what you pay for.” |
“Medical Assistants often have a great relationship with patients, and an interpersonal connection. I see the Medical Assistants in my practice stopping by patients’ doors and saying hello. They really have a deep connection. They could, with the right training, be important in getting the screenings done with the patients feeling comfortable.” | |||
The PHQ is not validated for clinician administration | 4 | “Self-directed PHQ-2 s are: (a) validated (it was how the tool was designed to be administered) and (b) gives the patient different options for how to fill it out (iPad, MyPennMedicine, etc.)” | |
Understanding the rationale for screening | Clinicians don’t understand | 2 | “The biggest problem is that many people don’t know what the concept of ‘screening’ is. It’s hard enough training residents on this, let alone medical assistants. For screening, you’re wanting to find the person who has slid under the radar, not the patient you already know has depression and is sad. That patient doesn’t need to be screened.” |
Patients don’t understand | 2 | “The patients are missing an explanation for why the practices are doing the screening in the first place and giving patients resources for what’s going to happen if they screen positive.” | |
Technological challenges | Health system technological challenges | 2 | “An idea that’s missing is that it is really hard to find the PHQ in PennChart [Penn Medicine’s version of Epic©] due to the way it’s configured. Doctors get very frustrated. Place it in a standard, permanent place in PennChart.” |
“In Psychiatry, no one knows where to find the PHQ-9 because they don’t have “vitals” on their dashboard. So, this presents problems.” | |||
Ideas | Themes | Frequency | Representative Quotes |
Reframing | Reframing is invalid | 4 | “Re-framing is the most surprising idea to me. I thought that we would see mostly self-report responses. The PHQ-2 is validated to be a self-report measure so it should be a self-report… Don’t change the items on the PHQ because it’s a validated measure.” |
“To me, the re-framing idea reflects the challenging piece that staff (medical assistants, residents, attendings) aren’t properly aware or trained about the PHQ-2 and aren’t fully knowledgeable about what screening is.” | |||
Patient self-report | Tablet computers in the waiting area | 5 | “Do the PHQ-9 on tablets during waiting room downtime.” |
“If looking at patient screening as a long-term project, the percentage of people who are comfortable with technology will increase over time. So, it’s not a bad investment in the long-term.” | |||
Patient education | Education is necessary | 5 | “Patient education is easy, quick, feasible to pilot. You can put signs in waiting rooms.” |
“One way to combine patient education and making this a workflow change, is potentially thinking about depression screening as the “fifth vital sign” like they did with pain.” |