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Universal Depression Screening, Diagnosis, Management, and Outcomes at a Student-Run Free Clinic

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Abstract

Objective

Student-run free clinics (SRFCs) are now present at most medical schools. Reports regarding SRFCs have focused on the infrastructure of established clinics, characteristics of the patient populations served, and their contribution to patient care. Few studies discuss their role in preventive medicine and even fewer discuss mental health care. This study examined the outcomes of a medical student-run universal depression screening, diagnosis, and management program at two SRFC sites.

Methods

Medical students implemented a universal depression screening, diagnosis, and management program within the electronic health record during routine adult primary care visits utilizing the Patient Health Questionnaire-2 (PHQ-2) as an initial screening tool, with a protocol to administer the Patient Health Questionnaire-9 (PHQ-9) if the PHQ-2 score was ≥3. This is a retrospective medical record review of visits from August 13, 2013, through February 13, 2014, to assess this program.

Results

Overall, 95.8 % (206/215) of the patients received either the PHQ-2 or the PHQ-9. Among the 174 patients without a previous diagnosis of depression, 166 were screened (95.4 %), of which 33 (19.9 %) had a positive PHQ-2 score of ≥3; 30 (of 33; 90.9 %) appropriately received a PHQ-9. Nineteen (of 166 screened; 11.4 %) previously undiagnosed patients were confirmed to have depression. Fourteen patients had two or more PHQ-9 tests at least 4 weeks apart and eight (57.1 %) had a clinically significant improvement, defined as PHQ-9 score decrease of ≥5. The prevalence of depression diagnosed prior to the implementation of this program in this cohort was 19.1 % (41/215) and after was 27.9 % (60/215).

Conclusions

This study demonstrated that medical students with faculty supervision can successfully implement a universal depression screening, diagnosis, and management program at multiple SRFC sites, identify previously undiagnosed depression, and work with interdisciplinary support services to provide treatment options, leading to a clinically significant improvement in depression severity.

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Acknowledgments

The authors would like to thank the patients and dedicated students of the UCSD SRFC Project who teach, motivate, and inspire us. We would like to thank our volunteers, community liaisons, and health promoters, especially Esmeralda Martinez-Preval and Isabel Dominguez, for their support and dedication to the UCSD SRFC Project including the implementation of this program. Finally we would like to thank Dr. Zephon Lister and Dr. Tyson Ikeda from the UCSD Department of Family and Preventive Medicine for their assistance with developing the depression screening and management algorithm; Charlene Atkins, MSW, and Jim Lovell, MSW, for providing social services and mental health referrals; Magaly Quintero and Carol Eames for helping with our electronic medical record (Epic); and the UCSD SRFC Project student managers for helping identify those patients needing to be screened at each visit.

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Correspondence to Maryam Soltani.

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Soltani, M., Smith, S., Beck, E. et al. Universal Depression Screening, Diagnosis, Management, and Outcomes at a Student-Run Free Clinic. Acad Psychiatry 39, 259–266 (2015). https://doi.org/10.1007/s40596-014-0257-x

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