Improving Depression Screening and Management in a Rural Primary Care Clinic

Background: Depression affects nearly 20% of the American population and incurs an economic burden of more than $300 billion in annual costs. According to the World Health Organization, more than 300 million people are affected worldwide. The U.S. Preventive Services Task Force recommends all patients over 18 years be screened for depression at least annually. Objective: At a rural primary care clinic, only 1.2% of patients were being screened for depression with no formal protocol for performing depression screenings. The purpose of the project was to implement an evidence-based depression screening protocol to improve depression screening, diagnosis, and treatment. Methods: The knowledge-to-action model served as the framework, while a retrospective chart review was used to aggregate data. Descriptive statistics were used for analysis. Interventions: A validated screening instrument, self-administration of the instrument, chart reminders, workflow redesign, and a treatment-decision algorithm were all used. Results: The overall screening rate improved from 1.2% to 35%. Depressive disorders were identified in 23% of the patient population. Among those screened, treatment consisted of a combination of pharmacotherapy (57%), mental health counseling (8%), both pharmacotherapy and counseling (22%), and a watchful waiting approach (13%). Strengths include the ease of administration of the screening instrument and office manager support. Limitations were lack of staff buy-in, simultaneous implementation of other projects, and the lack of technology. Conclusions/Implications for Nursing: Implementation of an evidence-based workflow redesign, including self-administration of a depression screening tool, can lead to increased screening, diagnosis, and treatment of depression.