The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held online from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.
A measurement-based care education program helped advanced practice providers increase monitoring and screening of patients for the presence and severity of major depressive disorders (MDD), according to a poster presented at the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. Self-evaluation in approaching patient treatment can result in meaningful changes in future practice, noted the study authors.
“Patients with residual symptoms of MDD represent the critical unmet need in successful disease management to restore normal functioning, quality of life, and health,” the researchers wrote. “One way to improve treatment results is through [the] use of quality indicators or measurement-based care.” Previous studies have demonstrated that, compared with usual care, measurement-based care — the use of evidence-based, routine symptom measurement as a treatment guide — improves outcomes in people with depression.
Researchers led by Denise Vanacore, PhD, FNP-BC, PMHNP-BC, evaluated the use of measurement-based care by advanced practice providers through a continuing education/continuing medical education activity in which participants self-assessed their current approach to managing patients with residual MDD. Each provider (n=469) chose 4 patients being managed for MDD and answered 18 questions about each patient. Eligible patients were between 18 and 60 years of age, in active treatment for a first or recurrent MDD episode, had a confirmed MDD diagnoses, and had been treated with the participating clinician as their primary healthcare contact for 2 to 3 months. Selected patients were also required to have residual symptoms despite receiving psychotherapy, antidepressants, or both.
Each participant completed at least 1 initial case evaluation: 357 participants completed all 4 initial cases and 93 completed the entire program, with a total assessment of 744 patients. Patients selected to be reviewed were generally young adults (60% women). Among clinicians who completed all program components, the researchers noted an increased use of patient monitoring and screening for both the presence and severity of MDD symptoms. The most frequently used evaluation tool was the Patient Health Questionnaire-9 (PHQ-9).
After the intervention, investigators noticed an increase in screening for cognitive symptoms; a significantly higher proportion of clinicians reported assessing for these symptoms compared with before intervention (72.9% vs 59.5%).
“[T]his practice improvement program demonstrates that education that allows practitioners who treat patients with depression to examine their own practice strategies with regard to the use of measurement-based care can result in meaningful changes in subsequent practice,” the authors concluded.
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Vanacore D, Gage A, Cohen R. Impact of educational interventions on use of measurement-based care in the management of refractory major depressive disorder. Presented at: APNA 34th Annual Conference; September 30-October 4, 2020. Poster 115.