A Presentation of Evidence and Effectiveness of Esketamine Treatments to Psychiatric Providers

Abstract

Purpose: This project intended to increase providers’ knowledge about esketamine and its effectiveness in combatting treatment-resistant depression (TRD) by presenting current research and discussing findings. We also aimed to assess providers’ attitudes towards esketamine and their attitudes toward evidence-based research, common standards of practice, and clinical practice guidelines. Background: Severe depressive symptoms leave patients at risk for suicide (Boland et al., 2022; Roberts, 2019). Arizona’s suicide mortality rates exceed US averages (AZDHS.gov). It is crucial for providers to find effective treatments that quickly ameliorate these severe depressive symptoms mitigating this risk. An outpatient behavioral health clinic recently began administering esketamine. High levels of evidence support the early effectiveness of this approach treating resistant depressive symptoms. Esketamine’s efficacy and administration practices are the focus of this quality improvement project. Methods: An evidence-based presentation on esketamine’s effectiveness to providers in an outpatient clinic using a pre/post-test design to measure changes in provider knowledge and attitudes about esketamine. Also measured attitudes towards evidence-based practice, common standards of practice, and clinical practice guidelines. The medical team comprised a convenience sample of voluntary participants. A dependent-sample t-test was used, looking for changes after the presentation/discussion. Results: Findings of this quality improvement project are presented using descriptive statistics. Clinician responses support the current use of esketamine treatment in this clinic. The findings of the dependent samples t-test showed no statistically significant changes in the post-test. However, all eight participants completed pre-test and post-test surveys before and after the presentation/discussion. Post-test responses indicated increases in the number of correct responses in three of the four knowledge questions by approximately 100%. There were also marked increases in favorability (degree of agreement) in three of the four attitude questions, including “likelihood to prescribe esketamine,” as well as using “evidence-based practices, common standards of practice, and clinical practice guidelines.” Conclusions: These findings for effective treatments assist providers by increasing their knowledge about newer treatments. They may facilitate favorability with these treatments in making treatment decisions with evidence-based research. Next steps in this quality improvement project (QIP) will measure maintaining esketamine treatments and patient outcomes including suicide rates.