Implementation of a collaborative care model to prevent, assess and treat anxiety and depression in cystic fibrosis patient
Cystic Fibrosis (CF) patients and caregivers have multiple risks factors for depression and anxiety as previously reported. Up to mid-2016 in our medical home, all patients 12 years and above were screened with the PHQ-2 and a follow up PHQ-9 if needed. Parents or caregivers were not formally screened or referred. In 2015, the Cystic Fibrosis Foundation and European Cystic Fibrosis Society published a consensus statements for prevention, screening and treatment of depression and anxiety.1 In 2015, only 3 of the 32 patients served during the year were diagnosed and only one was receiving psychotherapy and pharmacotherapy for depression and anxiety. Aim: In June 2016 we started a Quality Improvement project to implement the Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety. Using the PHQ-9 and GAD-7, CF patients age 12 years through adulthood, and of caregivers of children from birth to 17 years of patients were screened. The aim is to screen, treat or refer at least 80% of patient and at least one caregivers as needed. Results: Before implementation, 1 patient was already receiving treatment and 1 had declined. In this first quarter of the implementation (Q32016) of the 31 patients, 12 were seen for their quarterly visits, 5/12 were 12 year and above and screened. One patient scored “high” and was referred and was seen by psychiatrist, started on medication and psychotherapy. Of the caregivers seen the same quarter, 14 were screened and 7 (50%) of them scored high and were referred. 2/6 have started medication though their PCP and one is awaiting to be seen, 4 declined to address the problem. Correlation with patient demographic and financial data are being made. Conclusion: Anxiety and depression were found in several patients and caregivers in the first 3 months of the mental health guidelines implementation. A competitive grant was awarded for a clinical psychologist for ongoing intervention to patient and caregivers. References: International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety. Crossan A., Riekert K., Gartner S., Uluer A., Gerlach M., Zirbes J., Rounds J., (...), Reno K. (2016) Thorax, 71 (1) , pp. 26-34.