| Description |
Background: Generalized anxiety disorder (GAD) affects millions of adults in the U.S., yet less than half of those affected receive treatment. It disproportionately impacts individuals from low socioeconomic and minority backgrounds, many of whom face barriers to mental health care. In 2022, the U.S. Preventive Services Task Force (USPSTF) recommended universal anxiety screenings for adults aged 19-65, but these guidelines have not been fully implemented in rural healthcare settings. Local Problem: Summit County, Utah, is a rural county with 43,036 people; 11% of the population is Hispanic, and 27.2% is uninsured. The rural health department in Summit County currently screens for depression but not for anxiety, leaving a care gap for its vulnerable population. This quality improvement project aimed to implement the Generalized Anxiety Disorder 7 (GAD-7) screening tool for anxiety at every outpatient visit, particularly for women's health patients, to align with evidence-based standards, improve early identification, and increase mental health referrals. Methods: This project occurred at three rural public health clinics in Summit County, Utah: Park City, Kamas, and Coalville. The target population consisted of uninsured or underinsured Hispanic women, aged 18-65, seeking women's health services. Staff included nurse practitioners (NPs), registered nurses (RNs), front desk staff, and a nursing director. The project spanned from initial assessment to intervention implementation, beginning in late 2024. Interventions: The intervention involved routine anxiety screenings using the GAD-7 tool and a corresponding workflow algorithm. Phase one assessed current processes, created an action plan, and developed the algorithm, which was integrated into the clinic's electronic health record (EHR) system. A quick reference guide for mental health resources was also created. Phase two included staff education and live demonstrations. Screenings began in December 2024, with weekly Plan-Do-Study-Act (PDSA) cycles for feedback and improvements. Data on screening adherence, referrals, and patient outcomes were collected weekly. Results: The GAD-7 screening and workflow algorithm achieved 100% screening (n=20), with four patients (20%) screening positive. One patient required a behavioral health referral, and the algorithm was used in 30% of cases, although documentation was inconsistent. Providers generally expressed satisfaction with the process and workflow. Challenges included delays in patient resource handout approval and discrepancies in the Spanish GAD-7, which were addressed. The project improved the referral process and mental health resource targeting without incurring unintended costs. Conclusion: This project demonstrates that implementing anxiety screenings in a rural health clinic setting is feasible, sustainable, and cost-effective. Despite challenges such as delays and workflow revisions, the project successfully emphasized the importance of early anxiety detection in vulnerable populations. Findings highlight the value of screening to improve patient outcomes without significantly burdening staff or resources. As anxiety rates rise in underserved populations, ongoing adjustments to referral workflows and patient resources will be crucial for ensuring long-term success in rural healthcare environments. |
