ABSTRACT
STATEMENT OF PROBLEM/QUESTION: When COVID-19 emerged in March 2020, we transitioned to 100% telemedicine visits. We asked: 1. Is our practice providing equitable depression screening and care for patients after transitioning to telemedicine? 2. How might we improve access to care and increase equity for depression in our practice and systemwide? DESCRIPTION OF PROGRAM/INTERVENTION: In March 2019, we integrated mental health services at our academic faculty internal medicine practice consisting of over 5000 patients. We implemented the Collaborative Care model (University Washington, AIMS): 1) to consistently identify patients in primary care with distressing depressive symptoms, and 2) to quickly treat patients with distressing symptoms of depression. We began systematically screening patients for depressive symptom severity and treated using a team-based approach. The team-based approach included psychotherapy, psychiatric consultation, support for psychosocial needs, and online resources. MEASURES OF SUCCESS: We will describe our workflow and program evaluation measures. We explored whether differences in screening and treatment rates occurred based on age, sex and payor status comparing patients screened and treated one year before versus one year after the start of the COVID pandemic as we transitioned to using telemedicine. Patients were defined as “screened” if the Patient Health Questionnaire, 9-item version (PHQ-9) was administered at their physical examination, Annual Wellness Visit, or new patient visit. Patients were defined as“treated” if they enrolled in our mental health program and had more than one visit with the program psychologist. Chi-square tests of independence were conducted to determine associations between time period (Pre COVID vs Pandemic) and equity variables: age (<65 and 65+ years), payor (Medicaid vs. all others), and sex. FINDINGS TO DATE: The number of Annual Wellness, physicals and new patient visits dropped from 2,333 during the pre-COVID period to 1,464 during the pandemic period. The percentage of patients screened for depression using the PHQ-9 at physical examinations initially dropped, then increased dramatically in the Fall of 2020 and has trended back up to pre-COVID rates. Overall, our results may indicate we are offering equitable care. There were no significant differences in screening rates comparing the pre-COVID and pandemic periods stratified by age (p=.24), payor (p=.16) or sex (p=.32);patients who screened positive for depression, stratified by age (p=1.0), payer (p=.15) or sex (p=.22);or for patients who were treated on age (p=.14), payer (p=.51) or sex (p=.39). KEY LESSONS FOR DISSEMINATION: Screening and treatment of depression markedly improved in our primary care ambulatory setting since integrating mental health services. Depression screening after the start of the pandemic nearly ceased but has nearly returned to pre-COVID levels. Screening for depression in the clinic served to improve screening rates, but additional solutions are needed to modernizing telehealth tools for screening for depression.