Improving Depression Screening in the Era of SARS-CoV-2

From the 2021 HVPAA National Conference

Jesus Guzman (Texas Tech University Health Sciences Center El Paso), Kanchana Myneedu, Kavita Gupta,  Aimee Hechanova

Background

In 2017, the National Institute of Mental Health reported a 7.1% prevalence rate of major depression in the United States. Despite the high prevalence, screening rates in the primary care setting remain low as 4.2%. During the Covid-19 pandemic, there has been an unprecedented number of stressors leading to a 3-fold increase in depression. Studies have demonstrated that depression increase the risk of diabetes, hypertension, stroke, and heart disease. In an era of rising depression rates, how can we improve our screening and subsequently overall patient health.

Objective

Design a QI project to increase depression screening rates by at least 10% using the PHQ-2 and PHQ-9 in the Texas Tech Internal Medicine Resident Clinic.

Methods

After a thorough root cause analysis, we implemented the use of the PHQ-2 during the triage process and treated it as a vital sign. A positive screening triggered the administration of a PHQ-9. An easily accessible tab was incorporated into the EMR for proper documentation. Educational material was also made available to patients, and healthcare professionals alike. Pre-intervention data was collected from July 1 through September 30, 2020 and January 4 through January 22, 2021 to establish a baseline screening rate. Subsequent data was collected post-intervention from January 25 through March 23, 2021.

Results

Pre-intervention data showed that of the 896 patient encounters only 67 patients (7%) were screened with the PHQ2 and 77 patients (9%) were screened with PHQ9. Post intervention data showed that of 623 encounters, 371 patients (60%) were screened with the PHQ2 and 108 patients (17%) were screened with the PHQ9. The PHQ-2 showed a percentage change increase of 757% post-intervention and 88% increase in the PHQ-9 screening.

Conclusion

In this era of increasing instability and unpredictability, depression is on the rise creating the need for improving screening methods. Placing emphasis on mental health screening in the triage process has successfully improved depression screening rates in our outpatient clinic. The early identification and treatment for depression will improve our patient’s quality of life thus improving overall morbidity and mortality.