Abstracts

Rationale: Depression is seen in a high proportion of epilepsy patients, with estimates ranging from 20-50%. However, in clinical practice, depression in epilepsy patients is often under recognized and under treated. This may be detrimental to patient’s quality of life and compliance with medical treatment. American Academy of Neurology (AAN) epilepsy quality measures recommend yearly screening for depression and referral to psychiatric specialist when appropriate. Methods: A quality improvement project was undertaken over a two month period from January to March 2018 in our epilepsy clinics. Epilepsy patients completed Patient Health Questionnaire (PHQ-9) survey with assistance in the clinic waiting room. Survey was then scored by residents and fellows as part of clinic visit, and PHQ-9 score of 9 or greater is considered positive. If screened positive, patients received counseling and were offered referral to psychiatry. Patients were excluded if they were less than 16 years of age, severely cognitively impaired, unable to communicate, or non-fluent in English. We compared our study patients with matched controls and evaluated for rate of referral to psychiatry and documentation of depression screening in our electronic medical records. A chi-square test of independence was calculated. P values less than 0.05 were considered statistically significant. Results: 66 patients completed screening. 53% (n=35) of these patients scored positive for depression. Compared to care prior to intervention, patients were more likely to be referred to psychiatry (26% versus 6%), and more likely have depression screening documented in their medical records (68% versus 16%). The difference reached statistical significance with chi-square test value of 5.2 (P=0.02) and 15.7 (P< 0.01) respectively. Conclusions: In this quality improvement project, we demonstrated an intervention to improve compliance with depression screening. Our intervention was seamlessly integrated into existing clinic processes and did not significantly prolong visit length or wait time. Future studies would evaluate changes to long term outcomes such as quality of life and seizure control.  Funding: None