Date of Award
Evidence-Based Project Report
Doctor of Nursing Practice (DNP)
Julie M. Brandy
The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was appraised using appropriate tools and found to be sufficient for addressing the proposed clinical question. The evidence suggested that screening rates would experience the most improvement when using an MA screening protocol, using the PHQ-9, during patient check-in (Campbell et al., 2021; Gorman et al., 2021; Maust et al., 2017; Siniscalchi et al., 2020) and staff education (Costantini et al., 2021; Gorman et al., 2021; Heinz et al., 2021; Siniscalchi et al., 2020; Sinnema et al., 2018). Convenience sampling was used in this EBP project. Eligible patients included Medicare patients, 18 years and older, presenting for a scheduled appointment and due for an annual depression screening. Because of the large population size, random sampling was used for data analysis. The baseline group consisted of 130 patients, and the intervention group consisted of 128 patients. Following staff education, the clinic implemented an MA depression screening protocol using the PHQ-9 depression questionnaire during patient rooming. Key stakeholders included the project site facilitator and office manager, five clinic providers, the clinic’s MAs and administrative assistants, the patient population, and the organization’s human resources department. A Chi-Square Test of Independence was used to compare pre- and post-intervention depression screening completion rates, by provider, over a three-month data collection period. The primary outcome of this EBP project was increased depression screening completion rates for eligible patients following project implementation. Depression screening rates rose from 50% at baseline to 64% for the post-intervention group. A statistically significant (p = .023) higher percentage of people in the post-intervention group than in the pre-intervention (or baseline) group were screened for depression (x2 (1) = 5.203, p < .05). These findings indicate that staff education and an MA depression screening protocol, using the PHQ-9 tool, are effective for improving depression screening rates in older adults. Further research is needed to assess the effect of increased depression screening compliance on overall depression recognition and response to treatment, as well as health outcomes, in Medicare patients in primary care.
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Haluska, Kenneth J., "Improving Depression Screening Completion Rates for Medicare Patients in a Primary Care Setting" (2023). Evidence-Based Practice Project Reports. 199.
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