Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Loren Nelson

Committee Member

Dr. Lynne Jensen

Abstract

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% had follow up specific to depression, 13.4% had documentation of side effects education, and 19.4% received further mental health services. Among the comorbid groups there was no difference in the rate or degree of depression. Diabetic patients with depression had higher hemoglobin A1C levels than those with diabetes and no depression (p=0.00). Provider interviews identified the following barriers to depression screening: time constraints, difficulty with patients not following up, and lack of access/timeliness for mental health services.

CONCLUSION: In this clinic depression screening rates were above the average reported in the literature. Patients with diabetes were found to be at risk for worsening hemoglobin A1C levels with depression. There is a need for increased education regarding medications and timelier follow-up. Barriers still exist in completing screening and initiating treatment and referral to mental health services. An electronic medical record alert would be helpful in reminding providers to screen.

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