Ho, Matthew

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTFamily Practitioners’ Thresholds for Treating MajorDepressive Disorder and Generalized AnxietyDisorder in Lehigh Valley Health Network.Matthew HoUSF MCOM- LVHN Campus, Matthew.Ho@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHo, M. (2017, March). Family Practitioners’ Thresholds for Treating Major Depressive Disorder and Generalized Anxiety Disorder in LehighValley Health Network. Poster Presented at: 2017 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon, LehighValley Health Network, Allentown, PA.© 2017 Lehigh Valley Health NetworkIntroduction/Background ResultsConclusions The American Academy of Family Physicians (AAFP) lists major depressive disorder (MDD) and generalized anxiety disorder (GAD) as among the most common mental health problems addressed by primary care providers (PCPs).1 Mental health specialists (Psychiatrists and psychologists) are in short supply, requiring PCPs to meet theneeds of patients with mental health disorders.2 Family Physicians are trained to be able to diagnose and treat patients with MDD and GAD, however the reality is that they are limited by the resources.PROBLEM STATEMENTThe project aims to investigate physician thresholds for treating these disorders at LVHN’s Family Medicine offices while inquiring about resources and limitations to providing care.  •  LVPG Family Physicians commonly see and treat MDD and GAD.•  There is a gap between the availability and perceived usefulness of shared decision making tools and community oriented referral guides.•  Future initiatives should aim to:  –  Address the found resource gaps.  –  Search for more resource gaps.MethodologyA literature review was conducted on manage-ment of psychiatric disease in primary care. A survey was built using Qualtrics, accessed with USF privileges, and was piloted with 5 family physicians from separate practices with backgrounds in research and quality improvement. The survey was then submitted through the IRB Human Subjects Determination for Research and was deemed a Quality Improvement study. The online survey was then released to 90 Family Physicians within the Lehigh Valley Physician Group (LVPG) via e-mail. They were given two weeks to complete the survey, with a one week reminder. Results of the survey were evaluated by three components: 1  Use of a Likert scale to determine practice patterns in treating four mood disorders.   2  Comparison of averages between helpful resources and available resources.  3  Thematic analysis of free responses utilizing a word cloud. Word GraphReferences:1.  Pingitore D, Sansone RA. Using DSM-IV primary care version: a guide to psychiatric diagnosis in primary care. American Family Physician. 1998 Oct;58(6):1347-52.2.  Gonzalez J, Williams JW, Noël PH, Lee S. Adherence to mental health treatment in a primary care clinic. The Journal of the American Board of Family Practice. 2005 Mar 1;18(2):87-96.• Survey ParticipationRate: 31% (28/90)Figure 6. Word CloudDiscussion •  Responses suggest that LVPG Family Physicians are more likely to treat MDD and GAD before they would refer to Psychiatry. Free responses suggest that this may be due nee a need for psychiatry and how difficult it is to have patients acepted for mental health services•  On-site behavioral health specialists are perceived as both useful and available. This may suggest limited room for improvement in that area. If anything, the use of those on-site services was only validated further by this study.•  The resources that were identified in the study as lacking were shared decision making tools and community referral guides.90%80%70%60%50%40%30%20%10%0%On-site counselor/psychologistShared decisionMaking tools(medication vspsychotherapy)Community orientedReferral guidesDiagnostic Tools(PHQ, BDI, GAD-7)GrandRounds/LectureSeriesHelpful Resource Available Resource81% 85%67%40% 45%67% 71%85%19%35%Mean Responses of Helpful vs Available Resources forMild Depression54321See PatientIn PracticeRecommendMedication AloneRecommendPsychotherapy AloneRecommend Both Refer to PsychiatristMild Depression Severe Depression4.043.7Mean Responses of Helpful vs Available Resources forModerate DepressionGeneralized AnxietyModerate Depression 33.822.462.632.112.3232.441.812.89 3.183.744.363.431.862.153.152.21100%80%60%40%20%0%On-site counselor/psychologistShared decisionMaking tools(medication vspsychotherapy)Community orientedReferral guidesDiagnostic Tools(PHQ, BDI, GAD-7)GrandRounds/LectureSeriesHelpful Resource Available Resource90% 89%7153% 58%71% 76%84%33%47%Mean Responses of Helpful vs Available Resources forModerate Depression100%80%60%40%20%0%On-site counselor/psychologistShared decisionMaking tools(medication vspsychotherapy)Community orientedReferral guidesDiagnostic Tools(PHQ, BDI, GAD-7)GrandRounds/LectureSeriesHelpful Resource Available Resource95% 89%75%53%63%80% 85% 84%40% 47%Mean Responses of Helpful vs Available Resources forSevere Depression, Not Suicidal100%80%60%40%20%0%On-site counselor/psychologistShared decisionMaking tools(medication vspsychotherapy)Community orientedReferral guidesDiagnostic Tools(PHQ, BDI, GAD-7)GrandRounds/LectureSeriesHelpful Resource Available Resource95%84%67%53% 58%71% 81%79%33%47%Mean Responses of Helpful vs Available Resources forGeneralized Anxiety DisorderLehigh Valley Health Network, Allentown, PAFamily Practitioners’ Thresholds for Treating Major Depressive Disorder and Generalized Anxiety Disorder in Lehigh Valley Health NetworkMathew HoTable 1. DemographicsDegree n %M.D. 19 68%D.O. 9 32%GenderMale 5 18%Female 23 82%Age25-40 11 39%41-65 16 57%>65 yo 1 4%Years in Practice after Residency0-5 7 25%6-10 4 14%11-15 4 14%16-20 6 21%21-25 0 0%>26 7 25%Practice PopulationUrban 10 36%Suburban 13 46%Rural 5 18%

Family Practitioners’ Thresholds for Treating Major Depressive Disorder and Generalized Anxiety Disorder in Lehigh Valley Health Network.

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Family Practitioners’ Thresholds for Treating Major Depressive Disorder and Generalized Anxiety Disorder in Lehigh Valley Health Network.

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Lehigh Valley Health Network: LVHN Scholarly Works