| Description |
Background: Mental health disorders, including anxiety and depression, are prevalent among individuals with Phenylketonuria (PKU). These conditions can significantly impact quality of life, treatment adherence, and overall health outcomes. Despite the known psychological burden and risk of these conditions, routine mental health screening is not widely implemented in specialty metabolic clinics. Without a standardized approach to screening, many patients remain undiagnosed and untreated. Systematic screening using validated tools facilitates early identification and intervention, ultimately improving patient well-being and supporting a holistic care model. Local Problem: A local academic medicine clinic in Salt Lake City, Utah, provides specialized care for individuals with PKU. Historically, there has not been a standardized approach to mental health screening in this population. Discussions about mental health were inconsistent, and there was no clear clinical pathway for managing positive screening results. The absence of a structured process highlighted the need for a quality improvement initiative to integrate mental health screening into routine metabolic care. Methods: This quality improvement initiative followed the Johns Hopkins Evidence-Based Practice model to implement and evaluate a mental health screening process. Pre-surveys were distributed to a multi-disciplinary clinic team to assess knowledge and confidence in accessing, administering, and interpreting mental health screening tools. Open-ended questions aided the creation and education of a clinician toolkit. A post-survey was distributed 11 weeks after implementation to reassess participants' knowledge and confidence with mental health screening tools. Post-survey open-ended questions assessed satisfaction, usability, and feasibility. Pre- and post-surveys were paired, and the Wilcoxon signed-rank test was utilized for comparative analyses (α=0.05). Interventions: A clinical toolkit was created to guide targeted training on the importance of mental health screening, administration of the tools, interpretation of results, integration of results in the electronic medical record (EMR), and the designated clinical pathway for individuals who screen positive. Two education sessions and a mid-implementation check-in were held to counsel participants and obtain feedback on the process. During implementation, the EMR was assessed weekly to note the number of screens and mental health PKU clinic referrals completed for eligible patients. Results: The pre- and post-surveys were completed by 19 participants who primarily identified as white, non-Hispanic, females, ages 25-34, and were employed full-time with about 1 to 3 years of experience. The inferential analysis comparing pre- and post-survey results suggested several statistically significant improvements, with medium to high effect sizes, in accessing, administering, and interpreting mental health screening tools. EMR data showed 86.8% of eligible patients were screened, 36.5% screened positive for depression and/or anxiety, and among positive screens, 33.3% received a referral to the mental health PKU clinic. Conclusion: Implementation of a systematic mental health screening process in a specialty metabolic clinic is both feasible and beneficial. The project improved clinician confidence in regularly utilizing mental health screening tools for patients with PKU, aged 13 years and above. Post-project comments suggested participant satisfaction, usability, and feasibility of the initiative. Future efforts should focus on expanding diagnoses and integrating the tools with the EMR. |
