Implementation of Depression Screening in a Primary Care Practice

Abstract

Problem & Purpose: Depression is a common mood disorder that affects over 19.4 million adults annually in the United States. Depression is a leading cause of disability, absenteeism, and suicide. Primary care providers can diagnose and treat depression; yet, 50% of all depression diagnoses are missed in the absence of effective screening. Clinical practice guidelines support routine use of the Patient Health Questionnaire-9 depression screening tool among primary care patients. The purpose of this quality improvement project was to implement and evaluate the effectiveness of depression screening using the Patient Health Questionnaire-9 among adult patients at a suburban primary care clinic. Methods: The project was implemented by a team of primary care providers and nurse practitioner students during a 12-week period beginning in September of 2020. Staff and students received education on the importance of depression screening and intervention prior to implementation. Participants included primary care patients ages 18 or older who could speak and understand English, presenting for sick- or well-visits, either in-person or through telehealth. Participants were asked to complete the Patient Health Questionnaire-9 prior to their visit. Each patient’s sum score was calculated to determine presence of depression, severity, and assign corresponding interventions: watchful waiting, counseling referral and/or pharmacotherapy referral. Screening rates, specific scores, intervention rates, and specific interventions were collected weekly through chart audit and review of Patient Health Questionnaires. Results: Clinic personnel screened 61.3% (n=233) of eligible patients and 18.5% of these patients (n=43) had scores > 5 requiring intervention. All patients identified with depression were offered an intervention, of which 86% (n=37) accepted intervention and 14% (n=6) refused. Conclusions: The implementation of Patient Health Questionnaire-9 screening may increase rates of depression identification and facilitate treatment. Routine depression screening in primary care settings may guide patient management, staging of depression, and corresponding treatment plans.