Improving detection and treatment of anxiety and depression in a southwest Montana women's clinic: a quality improvement project

Abstract

Background: Depression and anxiety are the most prevalent mental health disorders affecting women. Primary care providers predominantly screen for and manage depression and anxiety, improving detection and treatment when adequate systems are in place. As many as 30% of women utilize an OBGYN provider for primary care yet are not typically screened for either diagnosis. Local problem: Rates of anxiety and depression in Montana are higher than the national average. Women utilizing the clinic's OBGYN providers for primary care were not being screened for these disorders. Methods: Over five weeks, Plan-Do-Study-Act cycles were completed weekly. Participants included women utilizing the clinic for annual wellness exams. Data gathered during the project included documented PHQ-9 and GAD-7 scores, and management metrics including behavioral health or psychiatry referrals, prescribed medications, immediate evaluations, and monitored patients. Interventions: Staff education occurred before the implementation date. PHQ-9 and GAD-7 scores were entered into the EHR during wellness exams. Staff surveys were emailed weekly to elicit feedback. PDSA cycles were performed utilizing data from chart audits and survey results. Results: The implementation was well received by both staff and patients. In the first five weeks following the implementation, chart audits demonstrated an average of 86 % of PHQ-9 and 81% of GAD-7 scores entered into the EHR. In addition, management metrics showed improvement in the last week of data collection. Conclusions: Implementation of screening for anxiety and depression during annual wellness exams allowed for early identification and treatment after shared decision-making. Screening was considered a valuable addition to the care provided by the clinic.