• Depression Screening Protocol for MS patients in a Neurology Clinic

      Yeasmin, Selina; Edwards, Lori A. (2021-05)
      Problem and Purpose: Depression is the most common symptom in Multiple Sclerosis (MS) patients with reported lifetime prevalence of 25-50%. Undetected and untreated depression in MS patients has been associated with poor psycho-social and treatment outcomes. Early detection and management of depression has been shown to ameliorate those negative outcomes and improve quality of life. Time constraints in ambulatory clinic settings can impact providers’ ability to perform a thorough psychological as well as physical evaluation. To address this gap adoption of a standardized depression screening tool in the care of MS patients was an important opportunity to address a critical need and improve quality of patient care. The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of a Depression Screening Program in adult ambulatory outpatient neurology clinic with MS patients using the Patient Health Questionnaire (PHQ-9) screening tool. Methods: The primary aim of this QI project was to implement a depression screening protocols for adult MS patients in an outpatient neurology clinic using the Patient Health Questionnaire-9 (PHQ-9), a validated depression screening instrument. Medical assistants (MAs) completed the PHQ-9 with patients during telemedicine visits. The MS providers reviewed and provided brief intervention and referrals if warranted. The project leader mobilized a site team, trained MS providers and MAs, mentored champions, tracked the project on a weekly basis, and provided the staff with weekly data updates. Results: PHQ-9 tool was utilized for depression screening in 144 out of 149 patients who had health visits during the 13-week period (97% compliance). Out those of 144 patients who were screened, 50% (n=72) were positive (PHQ-9 scores 5-27) for depression. 100% (n= 144) PHQ-9 scores were discussed and reviewed by MS providers. The treatment and referrals contributed to, 27.7% of patients were prescribed antidepressant,12.5% were referred to mental health providers. One patient had suicidal ideation, necessitating an urgent transfer to the emergency department (ED). Conclusion: Depression screening program using the PHQ-9 was adopted by the neurology clinic for MS patients. This program was able to identify depression in adult MS patients and facilitate treatment or referral to mental health providers. Early detection, treatment, or referral of adult MS patients with depression may help prevent ED visit or hospitalizations and will improve the quality of life for these patients.
    • Implementation of Depression Screening in a Primary Care Practice

      Flores, Jacqueline N.; Davis, Alison D. (2021-05)
      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.