Implementation of an evidence-based protocol to improve depression identification in primary care

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Montana State University - Bozeman, College of Nursing


This research project addressed a practice gap in the identification of patients experiencing depression in primary care. Depression is a significant cause of morbidity and mortality worldwide, including one million suicide deaths annually. One rural Western state has a depression rate more than three times the national rate, and the highest rate of suicide in the U.S., nearly double the national rate. The setting of interest was a primary care clinic in this state, and the following research question was asked: among adult patients, does the routine administration of the Patient Health Questionnaire-2 (PHQ-2) during wellness visits improve depression identification as compared to routine care? The project sample was gathered between May 2 and July 25, 2016, and consisted of 33 patients meeting the inclusion criteria gathered from a total patient panel of 1,479. Patients were screened for depression with the PHQ-2 during their wellness visits. Two new cases of depression were identified in the study group, compared to none in the control group. A randomization test, based on 5,000 trials, was done to assess statistical significance. The rate of new diagnosis with the depression screening tool was observed to be 0.062 with an associated 95% confidence interval of between 0 and 15.6%. Associated p-value was 0.243. Although 6.2% was not a statistically meaningful difference, this project holds clinical relevance. By implementing routine depression screenings, discussion of depression was found to be initiated more often, and patients' perceived barriers to seeking help for depression were addressed.




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