Standardizing Screening for Depression and Anxiety in Patients with Chronically Painful Conditions: A Quality Improvement Project
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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: Comorbid depression and anxiety occur at greater rates in patients who have chronic pain. The screening process for these conditions varies from provider to provider at an outpatient pain clinic. Purpose: The purpose of this quality improvement project was to determine the feasibility of standardizing depression and anxiety screening and offer referrals for patients meeting criteria who were seen in the outpatient chronic pain clinic. Methods: Providers placed an order for new patients scheduled to be seen in the pain clinic. This order assigned PROMIS Depression and Anxiety computer adaptive testing questionnaires for the patient to complete. Providers were able to place the order up to seven days prior to the visit. Patients were able to complete the questionnaires remotely through MyChart or during check in for their visit on tablets provided by the clinic. During the visit, the provider reviewed the results and offered a referral to behavioral health for further evaluation and consideration for treatment if the patient screened positive for anxiety or depression. Results: Completion rate of depression and anxiety screening questionnaires for new patients in the Pain Clinic was 44.4% and the proportion of completed questionnaires to questionnaires ordered was 25.8%. However, completion rates were impacted by the new patient no show rate of 45.5%. An exact Person chi square test for proportion difference in the pattern of behavioral health appointment outcomes was p = 0.78 showing no statistical difference in pre- and post-intervention behavioral health appointment outcomes. Additional data will be needed to analyze and view trends. Conclusions: Patients seen in the Pain Clinic received a consistent and more frequent opportunity for depression and anxiety screening. Modifications to the orders may result in increased screening completion rates. Additional data are needed to determine the needed modifications.
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