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1701 Improving completion rates of routine mental health screening for depression and anxiety in paediatric lupus outpatient clinic to enhance patient mental health care
  1. Tala El Tal1,
  2. Avery Longmore2,
  3. Abdulaziz Al Mutairi1,
  4. Audrea Chen1,
  5. Holly Convery1,
  6. Dinah Finkelstein2,
  7. Linda Hiraki1,
  8. Chetana Kulkarni3,
  9. Justine Ledochowski4,
  10. Neely Lerman1,
  11. Karen Leslie5,
  12. Deborah Levy1,
  13. Sharon Lorber6,
  14. Jayne MacMahon1,
  15. Jeanine McColl1,
  16. Sarah Mossad4,
  17. Oscar Mwizerwa1,
  18. Lawrence Ng1,
  19. Luana F Pereira6,
  20. Vandana Rawal5,
  21. Alaa Shehab1,
  22. Amani Al Bijadi1,
  23. Evelyn Smith7,
  24. Alene Toulany5 and
  25. Andrea Knight1
  1. 1The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto,ON, Canada
  2. 2The Hospital for Sick Children, Department of Paediatrics, University of Toronto, ON, Canada
  3. 3The Hospital for Sick Children, Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto,ON, Canada
  4. 4The Hospital for Sick Children, Department of Psychology, University of Toronto,ON, Canada
  5. 5The Hospital for Sick Children, Division of Adolescent Medicine, Department of Paediatrics, University of Toronto, ON, Canada
  6. 6The Hospital for Sick Children, Factor Inwentash Faculty of Social Work, University of Toronto, ON, Canada
  7. 7The Hospital for Sick Children, Division of Psychiatry, Department of Paediatrics, University of Toronto, ON, Canada


Background/Purpose Mental health (MH) problems are prevalent in adolescents with childhood-onset lupus (cSLE), with cross-sectional studies estimating prevalences of 20-60% for depression symptoms and 20-40% for anxiety symptoms. Despite this, MH screening rates are low. Identifying and treating MH symptoms early on is crucial as they are known to be associated with poor patient outcomes. A six-month chart audit (July 2021- Dec 2021) revealed a baseline median percentage of 17% of cSLE patients with documented MH screening in paediatric lupus outpatient clinic at The Hospital for Sick Children (Sickkids). In response, we aimed to: 1) increase percentage of cSLE patients (≥ 12-18 yo) with routine MH screening for depression (Patient Health Questionnaire-9 (PHQ-9)) and anxiety (Generalized Anxiety Disorder-7 (GAD-7)) from 17% to 80%, and if positive, 2) increase percentage of documented initial management (psychoeducation and/or referral to appropriate MH service(s)) from 22% to 80% in cSLE outpatient clinic by Sep 2022.

Methods This is a time series study analyzed with run charts. Root cause analysis was performed using fishbone diagram, 5Whys, and pareto chart. Patient and parent satisfaction surveys were conducted to determine their baseline satisfaction. Plan-Do-Study Act (PDSA) method was used to systematically evaluate and adjust process in real time. Family of measures included outcome measure – percentage of positively screened cSLE patients with documented initial MH management, process measure – percentage of eligible cSLE patients screened, and balancing measure – number of referrals to MH services, and time till seen.

Results Root causes identified included limited MH resources, lack of integration into clinic workflow, lack of standardized clinic algorithm for positive screens, lack of MH training of health care providers, and patient/family stigma and misconceptions. A series of site-specific change ideas (figure 1) were developed accordingly and implemented including 1) patients self-screened instead of administered by health care providers, 2) a standardized clinic algorithm, and 3) two 2-hour MH training workshops for health care providers. Over 50% of patients (n= 23) and parents (n=18) surveyed felt comfortable with routine MH screening, preferably in-person, and supported ongoing MH inquiry at future visits (figure 2). Patients emphasized privacy and confidentiality. Over six month period, 42 cSLE patients completed PHQ-9 and GAD-7 screens, increasing screening rate from 17 to 67%, of which 18 (43%) and 15 (36%) had positive screens respectively (figure 3). Of those, 10% (n=4) had moderate to severe scores and suicidal ideation. Six cSLE patients were referred and seen by appropriate MH service within 4-6 weeks. Majority screened (n=41) received psychoeducation and MH handout.

Conclusion Routine formal depression and anxiety screening is feasible in a busy subspecialty clinic. Next steps include ongoing screening, and ensuring appropriate follow-up plan for positive screens.

Abstract 1701 Figure 1

Driver diagram - lists key drivers, change ideas and family of measures used

Abstract 1701 Figure 2

Likert Scale Responses of Patients and Parents from Satisfaction Survey at Baseline

Abstract 1701 Figure 3

– Run chart of percentage of cSLE patients who completed screening for Depression (PHQ- 9) and Anxiety (GAD-7). Pie charts display results of PHQ-9 and GAD-7 screens, along with percentage of suicidal ideation among total of 42 cSLE patients screened.

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