Implementation of a Universal Adolescent Depression Screen in a Primary Care Practice: A Quality Improvement Project
Keywords:The PHQ-9 modified for Adolescents (PHQ-A)
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Introduction: The aim of this quality improvement project was to successfully identify adolescent depression by implementing routine screening. Methods: The PHQ-9 modified for Adolescents was utilized during annual wellness visits of patients ages 12-18 years at a mid-sized pediatric practice in Ohio. The total sample size was 184 patients after excluding 16 patients due to depression history. Data was collected on screening compliance, diagnoses, referrals, pharmaceutical treatment and survey scores. Results: Pre-implementation: 0% of patients were screened, 1.2% were diagnosed, referred and started pharmaceutical treatment. Post-implementation: 74.5% of the patients were screened, 13.3% were diagnosed, 9.2% were referred to behavioral health, and 6.1% received pharmaceutical treatment. Of those patients who were diagnosed with depression: 7.7% scored no or minimal range, 38.5% mild range, 23.1% moderate range, 7.7% moderately severe range, 23.1% severe range. Of those patients who were not diagnosed; 72.6% scored no or minimal range, 21% mild range, 4.8% moderate range, 1.6% moderately severe range, 0% severe range for symptoms scores on the PHQ-A. Discussion: Although this QI Project did not meet the aim of universal screening for depression, the results were promising. The project yielded a 74.5% increase in the number of adolescents who were screened for depression. Furthermore, there was a 12.1% increase of depression diagnoses and evidence of increased behavioral health referrals.
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