An Educational Intervention Using the Agency for Health Care Policy and Research Depression Guidelines among Internal Medicine Residents

Abstract

Objective: To determine if a brief educational intervention utilizing the Agency for Health Care Policy and Research (AHCPR) Depression Guidelines would effect improved recognition of depressed patients, as well as improved attitudes and knowledge, among Internal Medicine housestaff. Method: This was a randomized trial of an educational intervention for Internal Medicine residents. All patients attending the resident clinics were screened using the Center for Epidemiologic Studies Depression Scale. Persons scoring greater than 16 constituted the prospective cohort. Three hundred eighty-four patients were screened for entry into the study. Of 160 persons meeting the entry criteria, follow up was available on seventy-two (60%). Residents were randomly assigned to receive the educational intervention which consisted of three sessions where the residents received copies and instructions about the AHCPR depression guidelines and the use of a case-finding instrument for depression. Results: Non-recognized patients had milder symptoms of depression than did recognized patients. The presence of depressive symptoms was strongly related to measures of health status. Only seven of the seventy-two patients were identified as depressed and this was distributed equally between the two groups of residents. Intervention residents showed sustained improvement regarding depression criteria and the use of screening instruments at six months. Conclusions: A brief educational intervention effected changes in resident attitudes and knowledge regarding the care of depressed patients. Residents recognized patients with greater depressive symptoms than those with milder symptoms.