Implementation of Depression Screening Program in a Primary Care Setting

The U.S. Preventive Services Task Force recommends screening for depression in primary care settings. Limited access to mental health providers results in the need for primary care providers (PCP) to feel comfortable and confident screening and treating depression. Currently, usage of validated tools to screen and diagnose depression remains low in primary care. Therefore, it is critical to increase screening using validated tools in primary care. This scholarly project aims to bridge the gap between evidenced based guidelines and actual depression screening practices and diagnosis within the primary care setting. Evidenced based practice dictates PCPs screen and monitor patients with suspected depression using validated tools. One such tool is the Patient Health Questionnaire-9 (PHQ-9), which can generate a diagnosis of depression and a continuous score for monitoring treatment of depression. The PHQ-9 is a simple nine-question survey, which is easy to administer and interpret thus assisting in making informed decisions regarding treatment. Implementation of validated screening tools can result in improved outcomes, reduced visit times, and promote consistent follow-up among providers. Review of the literature demonstrates the economic cost of mental illness is upwards of $300 billion dollars annually. Improved mental illness treatment and outcomes sustains a large part of current research and available literature. Current literature supports the need for improved screening and diagnosis of depression in primary care. Importantly, multiple studies have demonstrated improved provider comfort and confidence using screening tools after education sessions along with structured screening programs. The following four objectives were met during this scholarly project. First, the gap between evidence based practice and depression screening in primary care was bridged by implementing a structured screening program. The program consisted of a short education session for PCPs and medical assistants (MA); the MAs then provided the PHQ-9 to patients older than 12 at any wellness and med-check visits; MA's entered PHQ-9 score into EHR system. PCPs evaluated the PHQ-9 score, and proceeded with appropriate interventions. Evaluation via retrospective chart reviews demonstrated a moderate increase in use of PHQ-9 by 48%. Second, the utilization of non-medical clinical staff in obtaining mental health screening resulted in increased numbers of patients being screened for major depression. Pre and post questionnaires were administered to PCPs and MAs, revealing an increased comfort with and use of the PHQ-9. Third, the use of pre and post questionnaires administered to participants demonstrated a high level of satisfaction and feasibility. Fourth, valuable feedback was provided to clinics, and through the submission of an abstract to the 2016 CME Snowbird Conference. Research and expert panels recommend screening adolescents and adults for depression in primary care. Review of the literature revealed use of structured screening programs increased use of evidence-based screening tools, via provider training and a team approach. This screening program can be easily utilized in other primary care clinics because implementation is straightforward and results support evidence based practice guidelines. The results of this scholarly project coincide with current research and evidence-based guidelines; with both providers and staff embracing utilization of the PHQ-9, resulting in improved compliance with evidence based practice.