PPRNet - Primary (Care) Practices Research Network

Depression

  • Periodic screening (at least every 2 years) for depression in all adults
  • Prescription of anti-depressant for patients with an active diagnosis of depression

The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up. The USPSTF explains that simple screening questions  ("Over the past 2 weeks, have you felt down, depressed, or hopeless?" and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?") may perform as well as more complex instruments but that any positive screening result should prompt a full diagnostic interview using standard diagnostic criteria (i.e., those from the fourth edition of Diagnostic and Statistical Manual of Mental Disorders [DSM-IV]) to determine the presence or absence of specific depressive disorders, such as major depression and/or dysthymia). The severity of depression and comorbid psychological problems (e.g., anxiety, panic attacks, or substance abuse) should be addressed.Treatment may include antidepressants or specific psychotherapeutic approaches (e.g., cognitive behavioral therapy or brief psychosocial counseling), alone or in combination. 

References: USPSTF Recommendations and Rationale  
                 

Alcohol Use

  • Screening for problem drinking and alcohol abuse at least every 2 years, with alcohol counseling for patients with a diagnosis of problem drinking/alcohol abuse.
  • Consider alcohol medication for patients diagnosed with alcohol abuse/dependence

The U.S. Preventive Services Task Force (USPSTF) found good evidence that primary care screenings can accurately identify patients who are at increased risk for morbidity and mortality but have not met the criteria for alcohol dependence. The USPSTF evidence also shows that brief behavioral counseling interventions with follow-up produce small/moderate reductions in alcohol consumption that can be sustained over 6-12 months or longer, as well as produce positive health outcomes 4+ years post intervention. Survey data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) show that nearly a third of all adults engage in risky drinking, some only occasionally and others frequently. As a group, however, nearly one in four of these risky drinkers already meets the criteria for alcohol abuse or dependence, and the rest have substantially increased chances of developing these disorders.Screening should involve a careful history of alcohol use and/or the use of standardized screening questionnaires. Additional information on how to implement screening in practice is discussed in the NIAAA reference below.  A growing body of research shows that primary care practitioners can significantly reduce both problem drinking and its medical consequences by conducting brief interventions. The brief intervention involves expressing concern when drinking levels are too high and agreeing on an action plan.  The NIAA also states that there are currently three oral medications (naltrexone, acamprosate, and disulfiram) and one injectable medication (extended-release injectable naltrexone) approved for treating alcohol dependence. In addition, topiramate has also been effective in treating alcohol dependence, however, it is not currently approved by the FDA for this purpose.

References:   USPSTF Recommendation Statement 
                    
Helping Patients Who Drink Too Much. A Health Practitioner's Guide (NIAAA)

Tobacco Use

Identification of patients who are tobacco users with cessation counseling for patients with a diagnosis of tobacco abuse.
The US Preventive Services Task Force (USPSTF) recommends that patients should be asked about tobacco use, and, if identified as a tobacco user, should receive tobacco cessation interventions.The USPSTF determined that combining therapy with counseling and medications is more effective than either componenent alone (FDA-approved pharmacotherapy include: nicotine replacement therapy, sustained release buproprion, and varenicline).

Reference: USPSTF Recommendation Statement


 



 
 
 
 
 
 

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