Full Clinical Guidelines - Community First Health Plans.

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12.1 Depression Mangement & Antidepressant Treatment Clinical Practice Guideline for Depression Management & Antidepressant Treatment This guideline is designed to assist practitioners by providing an analytical framework for the evaluation and treatment of patients, and is not intended to replace a practitioner’s judgement. Depression is a common health problem seen frequently in primary care and psychiatric settings. Depression is more common in young adults and adolescents, persons with a family history or personal history of depression, those with chronic illnesses, those who perceive or have experienced a recent loss, those with sleep disorders, chronic pain, or multiple unexplained somatic complaints. Screening of patients should occur yearly or as office visits and history indicate. Major Depression Screening Tool Must have a total of five or more symptoms for at least two weeks. One of the symptoms must be a depressed mood or loss of interest. 1. Depressed mood. 2. Markedly diminished interest or pleasure in all or almost all activities. 3. Significant (>5% body weight) weight loss or gain, or decrease or increase in appetitie. 4. Insomnia or hypersomnia. 5. Psychomotor agitation or retardation. 6. Fatigue or loss of energy. 7. Feeling of worthlessness or inappropriate guilt. 8. Diminished concentration or indecisiveness. 9. Recurrent thoughts of death or suicide. 10. Presence of psychotic symptoms. Patients with some depressive symptoms who do not fully meet the criteria for major depression often respond positively to antidepressant medication. Patients with indications of depression should be treated as deemed appropriate by the physician and may include a referral to a mental health provider. References Guide to Clinical Preventive Services – Second Edition, US Department of Health and Human Services, April 1989. Institute for Clinical Systems Integration, January 1997. Psychiatric Algorithms For Primary Care, Part 1, Primary Psychiatry, February, 2000. 96 H EALTH PLANS www.cfhp.com
ALGORITHM FOR TREATMENT OF MAJOR DEPRESSION WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Major Depressive Disorder Acute Treatment Goal: Decrease symptoms at least 50% Suggested Initial Dose of SSRI’s, Include (May need to be adjusted lower in geriatrics, debilitated, etc.) Fluvoxamine maleate 25mg po bid OR Citalopram hydrobromide 20 mg po q d OR Paroxetine hydrochloride 20 mg po q d OR Fluoxetine hydrochloride 20 mg q am OR Sertraline hydrochloride 50 mg po q am Escitalopram oxalate 10 mg q am **Practitioner should check current formulary guidelines for appropriate SSRI choices. Response After 6 weeks No Response Continuation Goal: Complete remission Duration for first episode: 6-9 months before taper and D/C Maintenance (Consider use of half tablets in Fluvoxamine maleate, Paroxetine hydrochloride, Escitalopram oxalate, Citalopram hydrobromide, Fluoxetine hydrochloride or QOD in Fluoxetine hydrochloride, if appropriate) Partial Response Increase Dose Citalopram hydrobromide 20 – 40 mg po q d OR Fluvoxamine maleate 50 – 100 mg po bid OR Paroxetine hydrochloride 20 – 40 mg po q d OR Fluoxetine hydrochloride 20 – 40 mg po q d OR Sertraline hydrochloride 50 – 100 mg po q am OR Escitalopram oxalate- 20mg q am Change antidepressant or referral After 6 weeks Partial Response Change antidepressant or referral H EALTH PLANS www.cfhp.com 97
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Examination/Test Oral / Dental Insp
Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47 and 48: Publication # 45-11647 Targets* A1
Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
Page 51 and 52: D. Optimizing analog insulin use Re
Page 53 and 54: Publication # 45-11266 Age 126 mg/d
Page 55 and 56: Hypertension Algorithm for Diabetes
Page 57 and 58: Lipid Algorithm For Type 1 and Type
Page 59 and 60: References: Revised 1-24-08 • Col
Page 61 and 62: WEIGHT LOSS ALGORITHM FOR OVERWEIGH
Page 63 and 64: Publication #45-11825 Screening 1 :
Page 65 and 66: Publication #45-12000 DIABETIC FOOT
Page 67 and 68: DIABETIC FOOT CARE/REFERRAL ALGORIT
Page 69 and 70: Publication # 45-12083 WEIGHT MANAG
Page 71 and 72: 9 H EALTH PLANS www.cfhp.com 71
Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
Page 75 and 76: Revised 10-25-07 Publication #: 45-
Page 77 and 78: Revised 2-21-08 Publication #: E45-
Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
Page 81 and 82: Orders for Adults with DKA and Hype
Page 83 and 84: D i a b e t e s t r e a t m e n t a
Page 85 and 86: CFHP has adopted the National Insti
Page 87 and 88: No CHD; 0 to 1, or 2+ Risk Factors
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Page 91 and 92: NATIONAL CHOLESTEROL EDUCATION PROG
Page 93 and 94: Identification, Evaluation, and Tre
Page 95: 11.3 Treatment of Hypertension H EA
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Page 103 and 104: CFHP PCP MEDICAL RECORD REVIEW TOOL
Page 105 and 106: 13.3 Specialist Medical Record Docu
Page 107 and 108: 13.4 Specialist Medical Record Revi
Page 109 and 110: Risk Factors for Osteoporosis Fract
Page 111 and 112: It is well documented that obesity
Page 113 and 114: CLASSIFICATION OF OVERWEIGHT AND OB
Page 115 and 116: 16.1.1 Preventive Pediatric Health
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Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
Page 125 and 126: CHILDREN’S SERVICES HANDBOOK P h
Page 127 and 128: CHILDREN’S SERVICES HANDBOOK P R
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Page 141 and 142: FIGURE 2: Recommended immunization
Page 143 and 144: Comprehensive antepartum care is vi
Page 145 and 146: The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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