458 - Behavioral health involvement to address adolescent depression in primary care: Are our consults equitable?
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 458 Publication Number: 458.216
Jane S. Manalo, University of Colorado School of Medicine, Broomfield, CO, United States; Ayelet Talmi, University of Colorado School of Medicine, Aurora, CO, United States; Jessica Kenny, University of Colorado School of Medicine, Aurora, CO, United States
Medical Student University of Colorado School of Medicine Broomfield, Colorado, United States
Background: Adolescent depression is a public health crisis that primary care clinics are addressing at high rates(Luoma et al., 2002). In primary care, 10-13% of adolescents report elevated depression symptoms (Forman-Hoffman et al., 2016). Prior studies have shown a positive correlation between PCP referral to behavioral health clinicians (BHCs) and an improved PHQ-9A in a follow up visit (Kenny et al., 2021). Integrating BH into primary care is the gold standard for addressing population-level BH (Talmi et al., 2016). More research is needed to understand demographic factors associated with primary care providers’ (PCPs) consultation of BHCs, which is a vital step in our work towards health equity. Objective: 1) Quantitatively characterize the percentage of PCPs who consulted BHCs, and who counseled patients without consulting BHCs, in response to elevated depression scores and reported suicidal ideation (SI) on the Patient Health Questionnaire (PHQ-9A; Johnson et al., 2002), 2) Determine whether there is a statistically significant difference in patient demographics for visits when a BHC was consulted and when PCPs counseled patients without consulting a BHC. Design/Methods: Between 1/3/17 – 8/31/18, 2107 adolescents completed the PHQ-9A at a primary care clinic with integrated BHCs. Clinical informatics were used to extract visit data and PHQ-9A scores. Conventional content analyses (Hsieh & Shannon, 2005) of Electronic Medical Records was used to code PCP consulting BHCs and PCPs counseling on elevated PHQ-9As without consulting BHCs. Qualitative codes were transformed into quantitative results. The results were then analyzed using chi-square tests. Results: 11% (N=277) of 2,107 adolescents had an elevated PHQ-9A (10+ and/or elevated SI), 7% (N=140) reported some frequency of SI regardless of overall score. Of the 277 with an elevated PHQ-9A, PCPs consulted BHCs 74% of the time and counseled on their own, without a BHC consult, 13% of the time. No significant differences were found among patients who PCPs consulted BHCs for. PCPs were more likely to counsel on their own without consulting BHCs for patients identifying as not Hispanic/Latino (χ2 = 11.48; p < .05).
Conclusion(s): PCPs are often on the front line of addressing adolescent depression (AAP, 2021).. The results of our study show that race and ethnicity may play an important role in whether a PCP provides counseling without involving BHC colleagues, which has significant implications related to health equity and access to high-quality, evidence-based care.
