Study Identifies Quality Indicators to Help Treat Veterans with HIV and Depression
Depressive disorders are the most prevalent psychiatric conditions among individuals with HIV, with rates as high as 30% to 50%. Moreover, patients with HIV and depression are at higher risk for accelerated HIV disease progression, decreased immune functioning, HIV medication non-adherence, and premature death. There are several performance measurement systems that include major depression quality of care indicators for general populations, but they do not include indicators that are specific to depressed patients with HIV. This article reports the results of an expert panel that was recently convened to create a comprehensive set of HIV depression quality indicators. The quality indicators were developed based on a review of the existing clinical guidelines for depression, particularly depression related to HIV, in addition to a review of the literature (134 articles). The panel rated 80 possible HIV depression quality indicators and approved 74%. Approved indicators that are more specific to HIV depression include: depression screening frequency, depression screening and treatment in the context of hepatitis C, optimizing depression and HIV treatment in the context of cognitive impairment, and starting antidepressants at lower doses but then advancing to doses typical for the general population. Authors suggest that quality indicators identified in this study provide a useful tool for measuring and informing the quality of HIV depression care.
Pyne J, Asch S, Lincourt K, Kilbourne A, Bowman C, Atkinson H, and Gifford A. Quality Indicators for Depression Care in HIV Patients. AIDS Care October 2008;20(9):1075-83.
This study was funded through VA/HSR&D’s Quality Enhancement Research Initiative (QUERI). Drs. Asch and Gifford are part of VA/HSR&D’s HIV/Hepatitis QUERI.