Quality Statement 12: Transitions in Care - Health Quality Ontario (HQO)

Major of Depression

Care for Adults and Adolescents

Click below to see a list of brief quality statements and scroll down for more information.

Quality Statements in Brief

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment
People suspected to have major depression have timely access to a comprehensive assessment.

Quality Statement 2: Suicide Risk Assessment and Intervention
People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.

Quality Statement 3: Shared Decision-Making
People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.

Quality Statement 4: Treatment After Initial Diagnosis
People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.

Quality Statement 5: Adjunct Therapies and Self-Management
People with major depression are advised about adjunctive therapies and self-management strategies that can complement antidepressant medication or psychotherapy

Quality Statement 6: Monitoring for Treatment Adherence and Response
People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.

Quality Statement 7: Optimizing, Switching, or Adding Therapies
People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.

Quality Statement 8: Continuation of Antidepressant Medication
People taking antidepressant medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking antidepressant medication and enter into remission are advised to continue their medication for at least 2 years after remission.

Quality Statement 9: Electroconvulsive Therapy
People with severe or treatment-resistant major depression have access to electroconvulsive therapy.

Quality Statement 10: Assessment and Treatment for Recurrent Episodes
People with major depression who have reached full remission but are experiencing symptoms of relapse have timely access to reassessment and treatment.

Quality Statement 11: Education and Support
People with major depression and their families and caregivers are offered education on major depression and information regarding community supports and crisis services.

Quality Statement 12: Transitions in Care
People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.

Resources Quality Statements Advisory Committee About

Transitions in Care

People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.

Background

Transitions between care providers can increase the risk of errors and miscommunication in a person’s care. It is important for people with major depression who are moving from one care provider to another to have a care plan that is shared with them and between providers. Optimal communication and coordination of treatment with other health care professionals lessens the risk of relapse and can reduce side effects. If the person is being referred to a new provider, it is important to ensure that the new provider accepts the patient before transferring them. A follow-up appointment after hospitalization helps to support the transition to the community. It can allow for the identification of medication-related issues; it also helps to maintain clinical and functional stability and aims to prevent readmission to hospital. It is especially important for people with major depression who are admitted to hospital with a high risk for suicide to be followed up soon after discharge. If the person’s consent is obtained, their family or caregivers should be notified of their potential risk for suicide.

What This Quality Statement Means

For Patients

If you move on to a new health care professional, you should each receive a written copy of your care plan from your previous health care professional and your first appointment should be scheduled within a specific timeline. For example, if you have major depression, you should see your new health care professional within 7 days of being discharged from hospital.

For Clinicians

When handing over a person’s care to another health care provider, ensure that the new provider accepts the patient, and that the patient and the new provider have a documented care plan within 7 days, as well as a scheduled follow-up with the new provider. When discharging a patient from hospital, ensure they have a scheduled follow-up appointment with a provider within 7 days of discharge.

For Health Services

Ensure systems, processes, and resources are in place to facilitate communication and the sharing of information between clinicians during care transitions. Ensure the system can accommodate the appropriate follow-up timelines.

Quality Indicators

Process Indicator

Percentage of people with major depression who transition from one care provider or care setting to another and have a documented care plan

Denominator: total number of people with major depression who transition from one care provider or care setting to another
Numerator: number of people in the denominator who have a documented care plan
Data source: local data collection

Percentage of people with major depression who transition from one care provider or care setting to another whose care plan specifies a timeline for follow-up

Denominator: total number of people with major depression who transition from one care provider or care setting to another who have a documented care plan
Numerator: number of people in the denominator whose care plan specifies a timeline for follow-up
Data source: local data collection

Percentage of people with major depression who transition from one care provider or care setting to another and have their care plan made available to the receiving provider within 7 days

Denominator: total number of people with major depression who transition from one care provider or care setting to another who have a documented care plan
Numerator: number of people in the denominator whose care plan is made available to the receiving provider within 7 days
Data source: local data collection

Percentage of people with major depression who are discharged from hospital who see a psychiatrist or primary care physician within 7 days of discharge

Denominator: total number of people with major depression who are discharged from hospital
Numerator: number of people who within 7 days of discharge of index hospitalization have at least one psychiatrist or primary care physician visit
Data sources: Discharge Abstract Database, Ontario Mental Health Reporting System, Ontario Health Insurance Plan Claims Database

Definitions Used Within This Quality Statement

Documented care plan

The following information should be communicated to the patient, family, caregivers, and the receiving providers prior to the transition:

Depression symptoms at the time of transition
Risk for suicide or self-harm, if any
Treatment history, including treatment options that have failed
Goals for treatment

Evidence to Improve Care