Integrating routine anxiety and depression screening in primary care: a quality improvement initiative

Abstract

Anxiety and depression are the two most prevalent mental health conditions experienced by the American population. In Montana, 163,000 adults reported experiencing a mental health condition. More than 35% of Montana adults reported experiencing anxiety and depression since the COVID-19 pandemic. Primary care providers are often the initial resource for patients experiencing anxiety and depression symptoms. Current literature supports screening adults 18 years and older for anxiety and depression at every patient encounter using reliable and validated screening tools like the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9). Local problem: Despite evidence supporting routine anxiety and depression screening in primary care, a rural primary care clinic struggled to implement routine screening consistently. Methods: The quality improvement project used the Plan, Do, Study, Act (PDSA) framework to assess patient compliance with screening tool completion, aiming to enhance early detection. Intervention: The GAD-7 and PHQ-9 screening tools were given to every adult 18 years and older. Results: Post- implementation analysis revealed that the highest completion rate for GAD-7 (78.3%) and PHQ- 9 (81.7%) occurred in week one. Contrastingly, the lowest screening rate for GAD-7 (34.9%) and PHQ-9 (36.7%) was in week 5. Additionally, referral rates and medication adjustments minimally improved, but follow-up visits increased. Conclusion: Despite not reaching the intended goal of 95% participation, routine anxiety and depression screening completion increased from pre-project to post-project implementation. Clinical judgment alone can fail to detect symptoms of anxiety and depression. Routine screening allows for timely intervention while decreasing the population's mortality risk.