Screening for post stroke depression by primary care physicians- an easy intervention of great importance

Olga Spivak, Rizan Sakhnini

Keywords: screening, stroke, depression, primary care

Background:

Post-stroke depression (PSD) is the most common neuropsychiatric complication after cerebrovascular accident (CVA) with a cumulative incidence of 55%, and is related to significant morbidity and mortality. In Israel, in 2016 screening for PSD became a quality measure in geriatric and rehabilitation centers via one of existing screening tools, including the PHQ-2 questionnaire.The optimal timing and setting for screening for PSD is yet to be established. Since primary care physicians follow these patients closely in an outpatient setting for long periods of time, their awareness of performing screening for depression in patients with new diagnosis of CVA is of great importance.

Research questions:

This study aims to compare the diagnosis rate of PSD by primary care physicians before and after introduction of a pop-up notification suggesting to perform screening for depression in patients with new diagnosis of CVA (in the past year)

Method:

This is a combined retrospective and interventional prospective study. Patients’ records with a diagnosis of CVA between 2016-2021 will be reviewed for the diagnosis of depression. Time elapsed until the diagnosis of depression, the expert making the diagnosis, treatment with antidepressant drugs and referral to a psychiatrist will be evaluated. Next, a pop-up notification with PHQ-2 questionnaire advising to screen for PSD will appear in all medical records of patients with a recent diagnosis of CVA. Patients scoring 5 ≤ points in PHQ-2 questionnaire will be evaluated according to DSM-5 criteria by a primary care physician or referred to a psychiatrist. After 1 year follow up, medical files will be reviewed once again according to the same criteria.
Hypotheses/outcomes:
Diagnosis rate of PSD between 2016-2021 made by primary care physicians is lower then what is known in current literature.
Diagnosis rate of PSD made by primary care physicians will be significantly higher after the introduction of a pop-up notification.

Results:

Conclusions:

Points for discussion:

Findings confirming our hypotheses will enable the use of pop-up notification to aid primary care physicians in screening for PSD, and thus improving patients chances for optimal rehabilitation.

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