Screening for Depression in Primary Care Practice

Abstract

Background Ineffective screening of depression in primary care practice contributes to the number of patients with poor quality of life and mismanaged care, leading to fatalities and higher healthcare costs to repair the system brokenness. Primary care providers have a leading role in communicating patient information, such as risk for depression and treatment options, National guidelines and goals exist for providers to effectively screen the general adult population for depression, in order to provide appropriate care and help patients to avoid suicide, implementing a standardized screening tool can improve patient outcomes and reduce costs in primary care practice, Local Problem Ineffective screening of depression was an observed and verbalized practice problem at a primary care doctor's office in a suburban location of Maryland. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the Patient Health Questionnaire-9 (PHQ-9) as a standardized screening tool to increase the detection of depression and appropriate treatment options for the general adult population. Interventions This quality improvement project occurred over a total of 14 weeks, including eight weeks of an implementation phase, During the first two weeks, a medical doctor and two medical assistants at a primary care office were instructed on how to implement and score the PHQ-9. The primary provider was also educated on the proposed treatment actions. The project leader assessed facilitators and barriers, and randomly selected patient charts of participants to review for data collection. Pender's Health Promotion Model (HPM) was used to guide this practice change. Results During the implementation phase, the primary me provider reported observing an increase in the number of patients diagnosed with depression, referred to psychiat7, and/or treated with a new antidepressant, based on PHQ-9 results. A significant number of adult patients completed the PHQ-9 questionnaire, while a smaller sample size was randomly selected for further data analysis (n= 95), Based on the ease of implementation and improved detection rates of depression, the staff within this primary care office continued to administer the PHQ-9 beyond the implementation phase. Results were saved within the patients' electronic health record. Conclusion Ineffective screening for depression in primary care practice continues to lead to adverse events. National guidelines supporting use of the PHQ-9 are recommended but not required for the general adult population. The large number of questionnaires administered during the implementation phase of this project was both a benefit and limitation, considering the extent of data analysis is to be completed in a short timeframe. Other limitations included the small number of staff involved and at two-week outage of the electronic health system in this office. Sustainability of this project may be obtained, as key stakeholders accept the organizational changes, benefit from the cost savings, and continue to improve quality of life.