PHQ-2 Workflow in an Urgent Care

The purpose of this quality improvement project was to implement the use of the PHQ-2 and PHQ-9 questionnaire in a rural urgent care setting. The project implementation began with a provider training on depression screening with a pre- and post-presentation survey, a seven-week implementation, and a post-implementation survey. The PHQ-2 workflow provided a stepwise process for patients entering the urgent care who were 18 and older without a primary care provider. The patients were provided a PHQ-2 depression screening tool with a PHQ-9 questionnaire following a positive PHQ-2, were appropriately diagnosed with depression, and referred to social work for further follow-up. The results of the pre- and post-presentation survey showed an increase in awareness of mental health being a concern in an urgent care and confidence to connect patients to mental health resources. The results of the process and outcome measures showed 24% of the 165 qualifying patients completed a PHQ-2 questionnaire. A total of 10% of the completed PHQ-2 questionnaires were positive. Seventy five percent of the positive PHQ-2 questionnaires had a completed PHQ-9, and one PHQ-9 had a score of 10 or more. Two depression diagnoses were made seven-weeks prior to implementation and two diagnoses were missed post implementation. The one PHQ-9 score greater than 10 had a referral to a social worker for follow-up. Lastly, the post-implementation survey showed an increase in mental health awareness and confidence in connecting the patient to mental health resources, 67% were satisfied and 33% were strongly satisfied with the PHQ-2 workflow. Common themes on how to improve the workflow were to make sure the PHQ-2 and PHQ-9 questionnaire was completed during patient rooming prior to the provider patient assessment and to provide more education on counseling resources. Recommendations include expanding the inclusion criteria to patients 13 and older and who have a primary care provider