OPTIMIZING THE USE OF MENTAL HEALTH DECISION AIDS IN THE OUTPATIENT SETTING

Purpose:

To increase the use of mental health decision aid (DA) materials in an outpatient primary care setting

Method:

In January 2015, we began a pilot project to increase DA use at a primary care clinic. Prior to pilot initiation, all providers were eligible to order any of 40 DAs, including flow managers, MDs, and RNs. As part of the project, we specifically trained flow managers to order mental health DAs focused on treatment options and self-management of depression, insomnia, and anxiety. For the first six weeks of the pilot, we utilized the patient health questionnaire 2 (PHQ-2), a validated screening tool to identify those at risk for depression. When a patient screened positive on the PHQ-2, flow managers offered that patient an order form listing brief descriptions of the three mental health DAs. After six weeks, the pilot was modified so that flow managers offered the DAs to all patients at their annual visit regardless of their PHQ-2 score.

Result:

In the three months prior to study initiation, a total of 12 DAs were ordered. Flow managers did not initiate any of these orders, and no orders were for mental health topics. In the first phase of the pilot with PHQ-2-based ordering,19 DAs were ordered, five of which were mental health related including four depression and one anxiety DA. Flow managers sent four DAs in total. During the second phase of the pilot with patient-triggered ordering, 203 DAs were ordered, 169 of them mental health DAs, including 62 for anxiety, 60 for insomnia, and 47 for depression. Flow managers initiated 164 of these orders.

Conclusion:

A pilot project geared toward expanding the use of mental health DAs in the outpatient setting led to increased use of DAs, particularly among non-physician providers. Non-physician providers may represent a previously underutilized resource to improve patient engagement in decision making. While the PHQ-2 is a validated tool for identifying patients who should be further evaluated for depression, we found that it severely undercaptured the number of patients interested in receiving DAs on depression and other mental health conditions. Future work should identify the patient motivation behind requesting these resources and whether or not requesting and reviewing a DA improves patient involvement in treatment decision making.