Implementation of a Depression Screening Tool in a Primary Care Clinic for Better Diagnosis and Treatment of Depression in Veterans

Depression is one of the most common mental health disorders seen by primary care providers in the United States and affects approximately 8% of the U.S. population (CDC, 2012). Depression is often seen more in low-income and low-social support populations, and it is often underdiagnosed and undertreated in the primary care setting (Maurer 2018). The Veterans Affairs research department estimates that one in three veterans who visit their primary care clinic have some symptoms of depression but one in eight veterans have major depression (VA Research on Depression, 2015). This paper explored primary care providers' education towards depression and their ability to diagnose and treat depression in the veteran population in a primary care clinic. It explored the effectiveness of educating clinic staff using evidence-based practices and a depression-screening tool--the Patient Health Questionnaire (PHQ-9)-- in aiding in the diagnosis and treatment of depression. In this study, licensed practical nurses delivered the depression-screening tool to all veterans prior to their visit with a primary care provider. The PCPs, after receiving the training, used the PHQ-9 to help diagnose, treat, or refer the patient to the mental health team for further assessment. A Likert-scale pre-and post implementation survey was given to clinical staff to measure if knowledge of depression treatment was increased after they received the education module. Based on the results, the training was successful, with a 40% increase in mental health referrals made by PCPs to the mental health team. The statistical significance of 4 of 11 survey questions, specifically questions 3,4,6, and 11 showed p values of (.046, .038, .024, and .023) (Appendix A). The knowledge level scores for questions 3,4, 6, and 11 improved from the pre-survery to the post-survery. Question 3 improved from a mean pre-survey score of 3 to an improved post- Implementation of a Depression Screening Tool 3 survey score of 3.44, question 4 had a pre-survey score of 2.33 and an improved post-survey score of 3.22, question 6 pre-survey score of 2.67 improved to a post-survey score of 3.67, and question 11 had a pre-survey score of 2.78 and improved to 3.67 post-survey. These scores represent that most providers went from rating their knowledge as average to being above average after depression education was received. Despite having a relatively small sample size, this project was successful in providing education to primary care providers about depression and to the clinic staff about how to treat patients. Successful implementation of the PHQ-9 depression-screening tool aided PCPs in the treatment and diagnosis of depression, resulting in increased referrals made to mental health professionals in the clinic