Abstract
Purpose: The purpose of this DNP quality improvement project was to increase depression screening in the adult population in a rural primary care setting by providing education to participants on screening and treating depression, identifying barriers to utilizing the PHQ-9 screening tool, and to determine if screening is leading to appropriate intervention.|Background: Depression is a leading cause of disability in adults aged 15-44 and can impair one’s ability to perform activities of daily living. While primary care providers see a large patient population, depression is often missed during routine visits. Depression is either not diagnosed or not treated appropriately in over 50% of the primary care population. In 2010, the average rate of depression screening in the primary care setting was less than 3%. Data shows that there may be a lack of knowledge on depression screening. Primary care providers play a vital role in diagnosing and treating the problem of depression, but the completion of screening and treatment remains a challenge.|Sample/Setting: For the purposes of this quality improvement project, the subjects were a primary care nurse practitioner and a family nurse practitioner student. This project took place at a rural primary care clinic in North Dakota.|Methods: The quality improvement subjects were given an educational handout and a pre-implementation and post-implementation survey aimed at assessing knowledge of current screening and treatment guidelines. Patients who are of 18 years of age and older were asked to complete a paper copy of the PHQ-9 questionnaire. Once this is filled out, the provider then assessed each result and determined appropriate pharmacologic and non-pharmacologic treatment. Participants completed a post-implementation survey to identify any provider and patient-specific barriers to using and completing the PHQ-9.|Results: Results showed the participant knowledge increased from pre- to post-implementation. 83 participants were screened with the PHQ-9 with 9% being scored as having depression. Of those with a positive screening, 5% received counseling and 2% received pharmacological treatment.|Conclusions: Depression screening rates in primary care are low and providers lack knowledge on depression and screening. However, with increased education, screening rates in primary care can be improved. Primary care providers play a vital role in diagnosing and treating the problem of depression.