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Primary Care Implementation of an Evidence-Based Protocol Addressing Women's Behavioral Health: An Interrupted Time
Seuli Bose-Brill1, Melissa Leonard2, Lisa M Christian3,4
1Combined Internal Medicine and Pediatrics Section, Division of General Internal Medicine, Department of Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Seuli.Brill@osumc.edu.
Journal of General Internal Medicine
|July 30, 2026
Summary
The Focus on ME (FOM) quality improvement initiative significantly increased anxiety and depression screening and treatment rates in primary care for US women of reproductive age. This collaborative approach demonstrated sustained improvements in behavioral health management.
Area of Science:
- Women's Health
- Primary Care
- Behavioral Health
- Quality Improvement
Background:
- US women of reproductive age experience higher rates of anxiety and depression compared to other adult populations.
- Primary care settings require effective interventions to overcome barriers in evidence-based screening and treatment for these conditions.
Purpose of the Study:
- To evaluate the impact of the Focus on ME (FOM) quality improvement learning collaborative on anxiety and depression screening and management rates within primary care.
- Assessing the effectiveness of a structured protocol implementation in improving behavioral health outcomes for women aged 18-44.
Main Methods:
- An interrupted time series analysis was employed to assess changes in screening and treatment trends before and during FOM implementation.
- The study included 20 Ohio primary care practices, analyzing data from 19,126 visits for women aged 18-44.
- Key outcomes measured were changes in Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) screening rates and the percentage of patients receiving protocol-aligned treatment (PAT).
Main Results:
- FOM implementation led to significant, sustained increases in GAD-7 screening (23.1%, p<0.05) and PHQ-9 screening (18.1%, p<0.001).
- Protocol-aligned treatment for anxiety increased by 25.9% (p<0.05) and for depression by 38.0% (p<0.001) post-implementation.
- Nearly half (49.4%) of the visits analyzed were with Medicaid beneficiaries, highlighting the intervention's reach within this population.
Conclusions:
- The Focus on ME (FOM) initiative demonstrated success in improving anxiety and depression screening and treatment within a statewide primary care network.
- The findings suggest that the FOM model is a promising approach for enhancing behavioral health management in primary care and warrants further investigation for broader implementation.
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