Text

theses

Purpose of Project:
Chronic medical illness (CMI) is the leading driver of increasing health care cost. Undiagnosed and untreated depression can add fuel, leading to serious repercussions in patients with CMI. Patients with depression are 2-3 times more likely to develop the chronic medical illness (CMI). Depression is one of the most common mental health disorders with lifetime prevalence of 10.8-16.2%. Depression can be easily detected in a primary care office where only 50% of patients are currently being diagnosed. Patients with CMI visit their primary care doctors on a regular basis which makes the primary care office the best place to detect depression. Depression screening can be easily done using the Patient Health Questionnaire (PHQ) -9, a self-administered tool. The goal of this hybrid project was to increase detection rate of depression in patients with CMI at a primary care office in a suburban area of southern New Jersey. This was achieved by screening participants with PHQ-9 during the initial or follow-up visit. A targeted qualitative question was also asked to better understand the patient’s perception of frequent depression screening. The goal was to screen approximately 40 participants within an 8-weeks period. Screening for depression in a primary care office helps us to increase access and delivery of quality health service. Increasing the number of patients diagnosed for depression will lower the incidence of suicide and help patients to receive treatment at the same place. Patient satisfaction will increase as well.

Methodology:
Project Type – Hybrid (Quantitative and Qualitative)
Setting – Solo primary care practice in a suburban area
Population – 18-89 years with at least one diagnosis of CMI
Recruitment strategy – Voluntary, convenience sample recruitment via flyers, and 1:1 approach
Consent procedure – Face to face interaction only in a private consultation room
Risks/Harm – Minimal risk and confidential (during the intervention, if participants get upset then he/she will be counseled/evaluated by the provider)
Cost/Compensation – Free, no compensation
Measurable Outcomes – PHQ-9 score and demographics

Results:
Total number of participants = 30 (n) of the 40 (target)
18 males (60%) and 12 females (40%)
Out of 30 total participants, only 1 was already diagnosed with depression and was not on any treatment for personal reason
10 patients refused to participant for unknown reasons
Most of the participants were
Married (n=20, 66.7%)
Asian (n=24, 80%)
Middle-aged (age 45-64, 50%)
Bachelor’s degree holder (n=19, 63.3%)

Implications for Practice:
Currently there is no existing mandatory policy related to depression screening other than routine wellness visit screening. Creating change at a national level will be an upstream intervention to address undiagnosed undertreated depression affecting large population throughout the United States. Policy should be made to cover the related cost by all insurance provider to decrease burden over the patient. Ultimately, it will lower the cost of maintenance of CMI and depression with improvement in quality of life. Additional training/education should be provided to the project site staff. Safety of the patient can be served if we can detect depression in-time and help the patient to obtain proper resources. Timely identification can help to increase life expectancy, treatment adherence and may lower suicide risk. Continuing education to both the provider and the patients is necessary

ETD_10930

DNP

Includes bibliographical references

doi:10.7282/t3-vn9h-2s63

ETD doctoral

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