(HealthDay News) — For patients with newly diagnosed breast cancer, tailored strategies for implementation of routine depression screening result in a greater proportion of referrals to behavioral care, according to a study published in the Jan. 4 issue of the Journal of the American Medical Association.

Eric E. Hahn, Ph.D., M.P.H., from Kaiser Permanente Southern California in Pasadena, and colleagues examined the effectiveness of an implementation strategy-guided depression screening program in a trial conducted at six medical centers with 1,436 patients diagnosed with new primary breast cancer. The centers were randomly assigned to either tailored implementation strategies (three sites; 744 patients) or education-only (three sites; 692 patients).

The program consisted of 9-item Patient Health Questionnaire screening and algorithm-based scoring and referral to behavioral health services; at tailored intervention sites, clinical teams received program education, audit, and feedback of performance data and implementation facilitation.


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The researchers found that 7.9 and 0.1 percent of patients at tailored sites and education-only sites, respectively, were referred. Referrals to a behavioral health clinician were completed by 44 of 59 (75 percent) and one of one patient at the intervention and education-only sites, respectively. Patients at tailored sites had significantly fewer outpatient visits in medical oncology in adjusted models (rate ratio, 0.86); no differences were seen in utilization of primary care, urgent care, or emergency department visits.

“Tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care,” the authors write. “Further research is needed to understand the clinical benefit and cost-effectiveness of this program.”

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