Introduction
Depression is a prevalent condition for which screening rates remain low and disparities
in screening exist. This study examines the impacts of a medical assistant screening
protocol on the rates of depression screening, overall and by sociodemographic groups,
in a primary care setting.
Methods
Between September 2016 and August 2018, a quasi-experimental study of adult primary
care visits was conducted at an urban academic clinic to ascertain the change in the
rates of completion of the Patient Health Questionnaire-2 after the implementation
of a medical assistant protocol (intervention) versus that of physician-only screening
(control arm). Analyses were conducted between April 2019 and April 2020 and used
interrupted time-series models with generalized estimating equations.
Results
A total of 45,157 visits by 21,377 unique patients were included. Overall, screening
increased from 18% (physician-only screening) to 57% (medical assistant protocol)
(p<0.0001). Screening increased for all measured demographics. With physician screening,
depression screening was less likely to occur at visits by women (than at visits by
men; OR=0.91, 95% CI=0.85, 0.98) and at visits by Black/African American patients
(than at visits by White; OR=0.91, 95% CI=0.84, 0.99). However, with the medical assistant
protocol, depression screening was more likely to occur at visits by women (than at
visits by men; OR=1.07, 95% CI=1.0002, 1.14) and at visits by Black/African American
patients (than at visits by White; OR=1.11, 95% CI=1.02, 1.20). In addition, age-related
disparities were mitigated for visits by patients aged 40–64 and ≥65 years (e.g.,
age ≥65 years: physician, OR=0.66, 95% CI=0.59, 0.73; medical assistant protocol,
OR=0.78, 95% CI=0.71, 0.85), compared with visits by patients aged 18–39 years.
Conclusions
Implementation of a medical assistant protocol in a primary care setting may significantly
increase depression screening rates while mitigating or removing sociodemographic
disparities.
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Article Info
Publication History
Published online: July 18, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
