Table 2.
Reported Provider Depression Treatment Practices
| Indicator | Response | Assigned scorea | n (%) |
|---|---|---|---|
| Assessment of depression | ■ Uses standardized depression measure with all patients | 5 | 10 (14%) |
| ■ Routinely asks all patients some screening question(s) | 4 | 13 (18%) | |
| ■ Asks only patients who exhibit signs of depression | 3 | 37 (51%) | |
| ■ Asks only when patients report depression or ask for treatment | 2 | 7 (10%) | |
| ■ No method identified | 1 | 5 (7%) | |
| Assessment of need for treatment | ■ Based on symptom-based threshold (i.e., standard cut-off score on standardized measure or clinical judgment of severity) | 3 | 48 (67%) |
| ■ Treats only when patient asks | 2 | 6 (8%) | |
| ■ No method identified | 1 | 18 (25%) | |
| Choice of treatment | ■ Clinical judgment based on depression history (e.g., prior treatments) and severity | 3 | 39 (54%) |
| ■ Patient asks for a specific treatment | 2 | 0 (0%) | |
| ■ No method identified | 1 | 33 (46%) | |
| Adjustment of starting dose for interaction with ARVs | ■ Yes (adjusts starting dose based on ARV regimen) | 2 | 26 (36%) |
| ■ No (does not adjust starting dose) | 1 | 46 (64%) | |
| First clinical follow-up after treatment initiation | ■ Within 2 weeks | 5 | 9 (13%) |
| ■ 2–4 weeks | 4 | 17 (24%) | |
| ■ 4–6 weeks | 3 | 19 (27%) | |
| ■ >6 weeks | 2 | 12 (17%) | |
| ■ At next clinic visit (∼3 months) | 1 | 13 (19%) | |
| How effectiveness is assessed | ■ Measures symptoms systematically | 4 | 6 (8%) |
| ■ Asks about symptoms | 3 | 40 (56%) | |
| ■ Patient reports symptoms | 2 | 19 (26%) | |
| ■ No method | 1 | 7 (10%) | |
| When medication is titrated | ■ Increases dose based on formal assessment of tolerability or efficacy | 4 | 26 (36%) |
| ■ Increases dose based on informal assessment of depressive signs and symptoms | 3 | 18 (25%) | |
| ■ Increases dose when patient asks | 2 | 15 (21%) | |
| ■ No method identified | 1 | 13 (18%) | |
| How high medication is titrated | ■ Full titration (will use full FDA-approved range) | 3 | 32 (45%) |
| ■ Some titration (will increase dose some but not use full range) | 2 | 34 (48%) | |
| ■ No titration (will not increase dose) | 1 | 5 (7%) | |
| When medication is changed | ■ Decision to change medication based on formal assessment of tolerability or efficacy; changes only after adequate trial | 3 | 12 (17%) |
| ■ Decision to change based on tolerability or efficacy, but not necessarily after an adequate trial | 2 | 45 (64%) | |
| ■ Never changes from initial medication | 1 | 13 (19%) |
a
Scores from highest (responses closest to best practices) to lowest (responses furthest from best practice).