PPRNet Practice Guidelines
Practice
guideline:
Periodic screening for depression in all adults
Prescription of antidepressant for patients with an active diagnosis of depression
The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up.
Many formal screening tools are available (e.g., the Zung Self-Assessment Depression Scale, Beck Depression Inventory, General Health Questionnaire [GHQ], Center for Epidemiologic Study Depression Scale [CES-D]). Asking two simple questions about mood and anhedonia ("Over the past 2 weeks, have you felt down, depressed, or hopeless?" and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?") may be as effective as using longer instruments. There is little evidence to recommend one screening method over another, so clinicians can choose the method that best fits their personal preference, the patient population served, and the practice setting.
All positive screening tests should trigger full diagnostic interviews that use standard diagnostic criteria (i.e., those from the fourth edition of Diagnostic and Statistical Manual of Mental Disorders [DSM-IV]) to determine the presence or absence of specific depressive disorders, such as major depression and/or dysthymia). The severity of depression and comorbid psychological problems (e.g., anxiety, panic attacks, or substance abuse) should be addressed.
Treatment may include antidepressants or specific psychotherapeutic approaches (e.g., cognitive behavioral therapy or brief psychosocial counseling), alone or in combination.
Additional resources:
USPSTF
Recommendations and Rationale
AHRQ
Clinician Summary Guide “Choosing Antidepressants for Adults"
Practice guideline:
Screening
for problem drinking and alcohol abuse with alcohol counseling for patients
with a diagnosis of problem drinking/alcohol abuse
The USPSTF recommends screening to detect problem
drinking for all adult and adolescent patients. Survey data from the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) show that nearly
a third of all adults engage in risky drinking, some only
occasionally and others frequently. As a group, however, nearly one in four of
these risky drinkers already meets the criteria for alcohol abuse or dependence,
and the rest have substantially increased chances of developing these disorders.
Screening should involve a careful history of alcohol use and/or the use of standardized screening questionnaires. Additional information on how to implement screening in practice is discussed in the NIAAA reference below. A growing body of research shows that primary care practitioners can significantly reduce both problem drinking and its medical consequences by conducting brief interventions. The brief intervention involves expressing concern when drinking levels are too high and agreeing on an action plan.
Additional
resources:
USPSTF
Recommendation Statement
Helping
Patients Who Drink Too Much. A Health Practitioner's Guide (NIAAA)
Tobacco Use
Practice guideline:
· Identification of patients who are tobacco users with cessation counseling for patients with a diagnosis of tobacco abuse
All patients should be asked if they use tobacco and should have their tobacco-use status documented on a regular basis. Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered assistance with cessation. Treatments involving person-to-person contact (via individual, group, or proactive telephone counseling) are consistently effective, and their effectiveness increases with treatment intensity (e.g., minutes of contact).
Numerous pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients who are attempting to quit smoking. Pharmacotherapies that reliably increase long-term smoking abstinence rates are varenicline (Chantix), Bupropion SR, Nicotine gum, Nicotine inhaler, Nicotine nasal spray, and Nicotine patch.
Additional resources:
USPSTF Recommendation Statement
Tobacco
Cessation Guidelines from the Office of the Surgeon General
Helping Smokers Quit: A Guide for Nurses
