Improving Depression Screening for Adults in Rural Louisiana

Abstract

Problem Statement: The adult and senior population of a primary care clinic in rural Louisiana lack depression screening. Purpose: This project aimed to improve screening for depression in a privately owned primary care clinic in adults 50 years of age and older residing in a rural parish in southern Louisiana. By Family Nurse Practitioners (FNPs) appropriately screening patients and improving diagnosis of depression, mental health barriers, and access to mental health services for rural patients will improve. Methods: A quality improvement approach of Plan Do Study Act (PDSA) cycles, each approximately one month in length, was utilized to assess if depression screening rates for adults ages 50 and older in a rural primary care clinic improved after a 3-month implementation of screening process using the PHQ-2 (2-item Patient Health Questionnaire) and PHQ-9. The project team, nurse practitioner, and clinic staff developed a process to improve screening rates for all patients ages 50 years and older who received care at the clinic between October 6, 2021, and January 6, 2022. Retrospective chart audits at months one, two, and three were completed to identify if the patients had been screened for depression. Descriptive statistics were used to evaluate if the screening rate had improved between cycles and within the overall time frame. Conclusion: Depression screening rates incrementally increased from 0% to 98% by the project's conclusion. After the first PDSA cycle, depression screening rose to 48.7%. After the second cycle, they increased to 91.1% and concluded at 98% with the end of the third and final PDSA cycle. New diagnoses of depression were made based on screening results during the second and third cycles. Implications: These findings have provided primary care clinics and their staff with solid support regarding depression screening of older adults in a primary care setting. Primary care providers, especially those in a rural practice environment, are better equipped to identify mental health disorders, such as depression when fully understanding the impact of utilizing a developed screening tool on all eligible patients. This study's results solidify the need to incorporate depression screening tools into routine patient care provided by NPs to identify mental health disorders in rural populations and adequately diagnose and treat these disorders to improve patient outcomes.