Evaluation of an electronic clinical algorithm to improve screening and evaluation of college students for depressive symptoms.

BACKGROUND: Depression is higher among college students compared with the general population, and lesbian, gay, bisexual, transgender and questioning/queer (LGBTQ+) persons have higher rates than heterosexuals. Evidence supports the implementation of automated depressive symptoms screenings to improve provider compliance. LOCAL PROBLEM: A student health clinic at a private, catholic university did not consistently collect Patient Health Questionnaire 2 (PHQ-2) and Patient Health Questionnaire 9 (PHQ-9) depressive screening scores or sexual orientation and gender identity (SOGI) data. METHODS: The Plan-Do-Study-Act method of quality improvement was used to improve depressive symptom screenings and SOGI data collection. Baseline assessment included a review of patient medical records during a 10-week period before the intervention. INTERVENTIONS: Patient Health Questionnaire 2 data were collected electronically and PHQ-9 data were collected automatically when indicated. Sexual orientation and gender identity data were added to the electronic intake form. The project was evaluated by: (1) comparing preimplementation and postimplementation compliance of PHQ-2 and PHQ-9 screenings; (2) assessing SOGI data collection; and (3) comparing LGBTQ+ and heterosexual student's PHQ-2 scores. RESULTS: Preimplementation data revealed a PHQ-2 compliance rate of 44.3%, with 0% PHQ-9 compliance, and no self-reported SOGI data collection. Postimplementation, PHQ-2 and PHQ-9 compliance increased to 93.2% and 100%, respectively. Patient Health Questionnaire 2 scores did not differ between LGBTQ+ and heterosexual students. CONCLUSIONS: The electronic clinical algorithm increased PHQ-2 and PHQ-9 data collection, supporting automated screenings for depressive symptoms. Collection of SOGI data also improved, thus potentially improving health outcomes. No differences between LGBTQ+ and heterosexual student's depressive symptoms were identified.

A first step in addressing medical education Curriculum gaps in lesbian-, gay-, bisexual-, and transgender-related content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program.

BACKGROUND: Individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, and/or born with differences of sex development have specific health needs and significant health disparities exacerbated by a lack of training among health professionals. The University of Louisville LGBT Health Certificate Program used an interdisciplinary approach to increase training, potentially enabling future physicians to provide quality healthcare to LGBT patients. METHODS: A pretest-post-test design was used to investigate medical students' (n = 39) attitude and knowledge outcomes after program participation. Attitudinal items with Likert-type responses were analyzed using the Wilcoxon signed-rank test. Baseline frequency and percentage of correct responses were tabulated for knowledge questions. At both pre- and post-test, the 11 knowledge items were summed to establish a total knowledge score, creating two total scores. The paired sample t-test was used to evaluate the pre- and post-change, and Cohen's D was used to assess effect size. All P values were two-tailed. Statistical significance was set by convention at P < 0.05. RESULTS: Students correctly answered 69% or less of the knowledge questions at baseline. Total correct knowledge scores significantly increased post intervention with the effect size being large (Cohen's D = 0.90, P < 0.001). Attitudes significantly increased post intervention on two items (P = 0.019 and P = 0.037). Some attitude items decreased post intervention: students felt it is more challenging to conduct a patient history with a LGB patient (pre-mean agreement = 2.44; post-mean agreement = 2.97, P = 0.018). CONCLUSIONS: Medical educators can play a critical role in decreasing LGBT healthcare disparities. The University of Louisville LGBT Health Certificate Program played an important first step in increasing medical students' knowledge and improving certain attitudes about LGBT patients.

Interprofessional LGBT Health Equity Education for Early Learners.

INTRODUCTION: The eQuality project at the University of Louisville aims to train future physicians to deliver equitable quality care for all people by creating an integrated educational model utilizing the competencies identified in the AAMC's Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD. This foundational interprofessional health equity session for early learners addresses knowledge and attitude milestones relating to interprofessional collaboration, professionalism, and systems-based practice competencies for lesbian, gay, bisexual, and transgender (LGBT) populations. METHODS: First-year medical students were assigned to interprofessional teams of approximately 10 health sciences students each. Students participated in a 75-minute session utilizing a group case study activity, including a systems lecture exploring social determinants and community resources related to LGBT health. Students collaboratively discussed the case and recorded strategies for optimal patient care. The Readiness for Interprofessional Learning Scale and health disparities attitudes and knowledge scales were administered pre-/postsession. RESULTS: One hundred fifty-eight first-year medical students participated in the session. Posttest scores reflected an improvement for all disparities knowledge items (p < .001), and an increased interest in working with other health professions students on future projects (p < .001). Changes in attitudes toward systemic and social factors affecting health were also observed. However, content analysis of worksheets revealed that only 36% of teams identified specific action steps for the case scenarios. DISCUSSION: This session was effective in improving knowledge and attitudes related to LGBT health equity and interprofessional education.

Kentucky Teen Institute: Results of a 1-Year, Health Advocacy Training Intervention for Youth.

The Kentucky Teen Institute trains youth throughout the state to advocate for policies that promote health in their communities. By evaluating two program summits held at universities, regularly scheduled community meetings, ongoing technical support, and an advocacy day at the state Capitol, the aims of this study were to assess the impact of the intervention on correlates of youths' advocacy intentions and behaviors and to assess youth participants' and other key stakeholders' perceptions of the intervention. An ecological model approach and the theory of planned behavior served as theoretical frameworks from which pre-post, one-group survey and qualitative data were collected (June 2013-June 2014). An equal number of low-income and non-low-income youth representing five counties participated in the Summer Summit pretest (n = 24) and Children's Advocacy Day at the Capitol posttest (n = 14). Survey data revealed that youths' attitude toward advocacy, intentions to advocate, and advocacy behaviors all improved over the intervention. Observations, interviews, a focus group, and other written evaluations identified that the youths', as well as their mentors' and advocacy coaches', confidence, communities' capacity, and mutually beneficial mentorship strengthened. Stronger public speaking skills, communication among the teams, and other recommendations for future advocacy interventions are described.