Abstract
Mental illness is prevalent in the US, yet is underdiagnosed and undertreated and associated with morbidity, mortality, and economic burden (NIMH, 2019b; NIMH, 2017; NAMI, 2019; Winerman, 2017). Primary care providers are vital in recognition and treatment of mental health conditions, however demands of time and competing priorities exist (Kroenke & Unutzer, 2017). Free clinics have higher prevalence of chronic conditions, yet providers encounter challenges to follow evidenced-based practice (Rahman et al., 2019; O’Brien et al., 2014). The setting of the quality improvement (QI) project was a free clinic that provides primary care to an underserved population. The sample included nurse practitioners (NP) and NP students at the free clinic. The QI project included education, toolkit development and implementation, and monitoring of provider barriers and sustainability. The toolkit included a screening protocol and provider resources for depression and anxiety. Results were analyzed using descriptive statistics. Twenty-nine post-visit provider surveys were completed indicating that 25 patients were screened for anxiety and depression with the PHQ-4 screening tool. Six patients were diagnosed with depression or anxiety. Three patients had medication prescribed, 4 patients were referred to therapy, and 6 patients were provided education. The BATHE technique was used in 5 patient encounters. Six final provider surveys were completed. All respondents found the mental health toolkit easy to use and assisted in addressing mental health and creating management plans. The results of this QI project demonstrated providers were compliant with the initiation of PHQ-4 screening tool and found the mental health toolkit easy-to-use and helpful in managing anxiety/depression. While few barriers were identified in screening patients, all students and NPs agreed that they would like to continue to use the mental health toolkit and PHQ-4 at the free clinic.