New tool aims to improve measurement of primary care depression outcomes
Positive measures can aid physicians in evaluating treatment success, U-M study says
Michael Klinkman, M.D., M.S., professor of family medicine at the U-M Medical School
Primary care doctors have long been on the front lines of depression treatment. Depression is listed as a diagnosis for 1 in 10 office visits and primary care doctors prescribe more than half of all antidepressants.
Now, physicians at the University of Michigan Health System have developed a new tool that may help family physicians better evaluate the extent to which a patient's depression has improved.
The issue, the researchers explain, is that the official definition of when a patient's symptoms are in remission doesn't always match up with what doctors see in a real-world practice, especially for patients with mild to moderate symptoms.
"There was a disconnect between the measurements and what people were feeling, so we knew we didn't have the whole picture," says study author Michael Klinkman, M.D., M.S., professor of family medicine at the U-M Medical School.
The study was published in the May/June issue of General Hospital Psychiatry.
"Rather than simply going down a list and checking off a patient's lack of individual symptoms, we believe there are also positive signs that are important -- a patient's feeling that they are returning to 'normal,' their sense of well-being, their satisfaction with life and their ability to cope with life's ups and downs," says lead author Donald E. Nease Jr., M.D., adjunct professor of family medicine at U-M.
The researchers developed a series of five questions-- such as, "Over the last two weeks, did you feel in control of your emotions? -- that they hope will help doctors better understand a patient's inner landscape.
The remission criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) doesn't necessarily correspond to a patient's own sense of recovery, says Klinkman, also a member of the U-M Depression Center.
For example, a patient could meet all the criteria for full remission, but still not feel that he had recovered. The U-M questionnaire, which is called Remission Evaluation and Mood Inventory Tool, or REMIT, is intended to add the patient's subjective sense of recovery into the equation.
Rather than a replacement for current tools and measurements, REMIT is intended to complement them. But unlike other tools that require a company's permission to use, the REMIT tool is available without charge to any physician or other provider who wants to use it.
The researchers used the REMIT tool alongside the Patient Health Questionnaire (PHQ), the current "gold standard" for monitoring people with depression.
The data showed that by adding in the REMIT questions, about one-third of patients with mild depression were not in remission, as their PHQ score would indicate. Additionally, about one-third of moderately depressed patients were doing better than their PHQ scores alone would denote.
"Using just the PHQ score across our study population, we saw about 60 percent accuracy in reflecting a patient's remission compared to the patient's sense of his or her own recovery," says Nease, who was an associate professor at the time of the research. "If you add in the REMIT questions, we get above 70 percent. This can give doctors new insights when making treatment choices, such as changing a patient's medication or dosage."
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