Implementing Training Modules to Facilitate the Patient Health Questionnaire-2&9 (PHQ-2&9) Screening Administration for Improving Depression Screening in a Local Free Clinic

Background: Major depressive disorder affects approximately 9 percent of the adult population annually and has a 17 percent lifetime prevalence in the United States (Maurer, 2012; Meyer & Grob, 2014; NIMH, 2015). Adult depression occurs more frequently in low income and uninsured populations in the primary care setting, however, it is often underdiagnosed and inadequately treated due to a lack of screening despite the large number of effective screening tools such as the PHQ-2&9. The PHQ-2&9 are commonly used validated screening tools that have a 97 percent sensitivity with 67 percent specificity (PHQ-2) and a 61 percent sensitivity with 94 percent specificity (PHQ-9) in adults (Maurer, 2012). According to American Family Physician (2012), the U.S. Preventive Services Task Force found sufficient evidence that depression screening in primary care settings will aid depression treatment and decrease morbidity in the adult population (Maurer, 2012). Aims: The purpose of this project was to implement screening and appropriate treatment of depression in low-income and uninsured patients in the primary care setting. This project has the potential to result in relieving the burden of depression, and increasing patients' quality of life. Setting: A local non- profit free primary care clinic. Participants: Patient technician trainers working at a local volunteer free clinic. Methods: Qualified patient technician trainers were recruited to participate in test training for implementation of the PHQ-2&9 screening during the clinic's quarterly meeting. Eleven patient technician trainers who participated in the training completed pre- and post- training questionnaires to validate the success of the education provided. The participants were then contacted eight weeks after the training to assess the continued use of the training materials with current and new patient technicians. Lastly, the clinic was contacted to confirm successful implementation of the PHQ-2&9 screening with all adult patients in the clinic. Results: Based on data results, the training was successful. Prior to training, the pre-test had a mean score of 4.1 that increased to 9.3 out of a maximum score of 10 with the post-training (p-value < 0.05). A final version of training modules was distributed to all PTCs through email and the clinic successfully implemented the PHQ-2&9 as routine screening for all patients. Conclusion: Despite this project having a relatively small sample size, it was able to aid in the successful implementation of the PHQ-2&9 in a local free clinic with limited funding through the guidance of the training modules for patient technician trainers. In follow-up, the clinic is reporting that the screening of all patients has picked up on depression cases that would have otherwise been missed.