Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Jessica Sass

Committee Member

Dr. Sharon Lock

Abstract

Background: Within primary care patients identified with depression often do not receive appropriate care (43%). Guidelines recommend combining pharmacotherapy and psychotherapy when possible and establishing follow up with patients to improve their response to treatment According to the APA, only 10% of patients receive combination therapy.

Purpose: The purpose of this study was to evaluate depression management practices in a primary care clinic, describe providers’ attitudes and skills related to depression treatment, and work with the healthcare team to identify strategies to improve depression management within the clinic.

Methods: A single site, descriptive study utilized a retrospective chart review of 115 patients with a PHQ-9 score greater than or equal to 10. A provider questionnaire assessed perceptions and attitudes of depression management and identified barriers to management in current practice.

Results: Of the 115 patient charts, the average PHQ-9 score was 14.7 (SD=3.9). Based on guideline recommendations, 100% of visits would have expected combined therapy and documentation of follow-up within four weeks. However, 43% of patient visits had documentation for combined treatment, 58% of visits had a follow up for the patient, and the average time frame was 6.5 weeks. The top barrier identified to depression management was lack of availability of mental health services (M=4.00, SD=1.12).

Conclusion: This clinic is providing appropriate management when compared to national statistics. Areas of improvement include increasing documentation of behavioral health discussion and follow-up and decreasing follow-up time frame. Availability of mental health services is being improved with the integration of behavioral health and family medicine.

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