Improving Adolescent Depression Identification in the Primary Care Setting with Standardized Screening

Abstract

Purpose: The purpose of this DNP quality improvement project is to encourage the adoption of the PHQ-A tool to better identify adolescent patients that are at risk for depression in this primary care setting. Background: Depression is a common mental disorder affecting individuals across the lifespan and is one of the most prevalent psychiatric disorders in ages 12-18 years old. Approximately 9% of adolescents will experience depression, and roughly 20% of youth will experience depression before the age of 18. The incidence of depression during the most crucial developmental stages in adolescents is associated with impairment psychosocially, cognitively, and academically. In addition, depression during adolescents has a strong association with substance abuse, low self-esteem, and higher incidences of suicide. Methods: Persons of interest were medical assistants, nurse practitioners, physicians, and physician assistants providing care to children ages 12 through 18 in a primary care setting. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention using a pre-test, post-test, and quantitative design. Providers and medical assistants were invited to attend an educational presentation at their monthly office meeting, completing a pre-test on adolescent depression prior to the presentation, then post-test after to evaluate their knowledge surrounding adolescent depression and intention to screen using the PHQ-A. The medical assistants were then asked to screen all adolescents within the age range at well-child visits. The results of the PHQ-A were shared with the providers. Results: Data collection took place over two weeks. Five providers and five medical assistants completed both the pre-test and post-test surveys. The providers and medical assistants’ knowledge scores increased by 21% after participating in the educational presentation. In addition, there was an 84% increase in the utilization of the PHQ-A screening tool. Conclusion: DNP quality improvement projects like this assist in developing strategies to provide best practices, increasing positive patient outcomes. Projects such as this, allow for nurse-led improvements and contributions to healthcare and the advancement of the nursing profession. Results may be used to develop protocols for the early identification and treatment of adolescents with depression.