Use of the Depression Medication Choice Decision Aid for Antidepressant Prescribing in Primary Care

Abstract

Purpose: Primary care providers (PCPs) are well placed to diagnose and treat patients who have symptoms of depression; however, they may not have comprehensive knowledge of the subtle variations in antidepressant medications (ADMs) used in first-line treatment of depression. The purpose of this quality improvement project was to implement the Depression Medication Choice Decision Aid (DMCDA), an evidence-based decision-making tool created by Mayo Clinic. This tool is designed to aid PCPs in collaborating with patients for initial ADM selection in the adult population. Methods: Six PCPs from two sites, one student health clinic and one rural health clinic, were recruited to implement the DMCDA tool. A survey was given pre- and post-intervention to assess provider attitudes, skills, and behaviors related to prescribing ADM in the primary care setting. Charts were reviewed to determine whether PCPs were documenting the use of the tool and to compare pre- and post-intervention patient adherence to therapy and follow-up appointments. Results Survey results showed an overall increase in attitude and skill mean scores, with mixed results for behaviors. Providers documented use of the DMCDA in fifteen out of sixteen post-implementation patient encounters. Twelve out of 13 follow-up appointments were kept, and 10 out of 14 patients remained on therapy through follow-up. Implications Use of the DMCDA in the selection of ADM may improve patient-provider collaboration, improve provider perceptions regarding the treatment of depression in the primary care setting, and improve patient adherence to scheduled followup appointments and prescribed ADM.