Incorporating psychosocial screening into practice crucial for diabetes clinics
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Key takeaways:
- Health care providers should screen for diabetes distress, disordered eating behaviors and fear of hypoglycemia.
- More research is needed on psychosocial screening measures for non-English-speakers.
Analyzing psychosocial health and patient-reported outcomes is necessary when treating people with diabetes, and practices should incorporate screening into routine care, according to a review article published in Current Diabetes Reports.
“Symptoms of depression, anxiety or distress and contextual factors related to social determinants of health can profoundly impact diabetes management and are highly relevant to person-centered care,” Sarah D. Corathers, MD, associate professor and clinical director of the division of pediatric endocrinology at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, told Healio. “Strength-based approaches that assess quality of life, confidence and resilience can provide clinicians opportunities to bolster these areas to improve health outcomes.”
Corathers and colleagues outlined several domains of patient-reported outcomes that are typically assessed for people with diabetes. Two of the most common domains assessed are depression and anxiety, and providers can screen for both conditions through a combined approach using questionnaires such as the Patient Health Questionnaire-9 or the General Anxiety Disorder-7. Diabetes-specific domains that providers should consider analyzing include diabetes distress, disordered eating behaviors and fear of hypoglycemia. Universal and structured screening for social determinants of health should be included in any assessment of patient-reported outcomes.
To assess psychosocial screening in diabetes clinics, a 22-item clinical practice survey was administered to 24 pediatric centers and eight adult clinics in the T1D Exchange Quality Improvement Collaborative from Oct. 5 to Nov. 19, 2021. Of the pediatric clinics, 96% reported using at least one standardized screening tool and 79% reported using two or more. Of the adult clinics, half stated they used at least one screening tool.
Challenges with psychosocial screening
Depression was the most common domain assessed, with 96% of pediatric clinics and 38% of adult clinics assessing depression. The most common questionnaires used were the Patient Health Questionnaire-9, used by 24 of 32 clinics; the Patient Health Questionnaire-2, used by seven clinics and the Hunger Vital Sign-2, used by six clinics. Additionally, 13 clinics reported screening for social determinants of health and five screened for disordered eating without specifying the measures used.
The most common challenges reported during screening were time constraints, difficulty integrating screening into workflow and determining how to react to patient responses, especially in clinics with limited social work or mental health resources.
“Diabetes is a lifelong condition, yet the resources in pediatric and adult health care settings to address psychosocial concerns are vastly different,” Corathers said. “Adult centers report limited access to social work and mental health referral resources services with lower likelihood of embedded interdisciplinary team members as compared to pediatric health delivery settings. These health system gaps translate into lower rates of psychosocial screening in adult health care contexts despite recognition of the ongoing relevance across the life span.”
Incorporating screening in routine care
The researchers discussed several strategies to assist diabetes clinics with incorporating psychosocial screening into practice. Some of the strategies include selecting the best screening tools for their specific patient population, determining how frequently to administer screening, whether to use a paper-pencil form or use electronic devices to conduct screening.
“Strategies to make psychosocial screening efficient and reliable reported by centers in the T1D Exchange Quality Improvement network include use of tablets that integrate responses into the electronic health record with build-in clinical decision supports to help clinicians interpret the responses and guide referral actions,” Corathers said. “Clinics may stagger patient-reported outcomes across visits to limit burden but still capture multiple domains over time or employ an adaptive frequency of screening based on prior scores that allows for more frequent monitoring of the higher-risk individuals that does not overly assess the low-risk population.”
The researchers also emphasized the importance for clinics to invest time and resources into screening by training their staff and determining their clinical thresholds for each survey that may warrant interventions.
Corathers said more research on psychosocial screening measures for non-English-speaking populations should be conducted to expand existing tools and ensure the validity of questionnaires when administered in other languages. She added that a stronger effort to engage all stakeholders in the psychosocial screening process could help improve logistical facets, overcome barriers and increase sustainability and inclusivity.
For more information:
Sarah D. Corathers, MD, can be reached at sarah.corathers@cchmc.org.
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