Implementation Barriers of the PHQ-9 in Primary Care: A Quality Improvement Project

Purpose: The purpose of this research translation project was to mitigate the consequences of under-recognition, and under-treatment of depression through use of an evidence-based depression-screening tool, the PHQ-9, in a primary care setting.: A plan-do-study-act model was utilized for the implementation of this initiative. An informal educational intervention about administration and interpretation of the PHQ-9 first took place at the provider level in a primary care practice. Next, a pre and post-test study design (n=12) was administered to providers, nursing, and ancillary staff. A report was shared at monthly quality meetings with representatives from each practice in the health system. Finally, a system-wide initiative for administration of the PHQ-9 was adopted. A matched pairs t-test was used to analyze the practice-wide educational initiative. Administration of the PHQ-9 was tracked system-wide at quarterly intervals.: The change in depression screening between quarters 1 and 4 was 42.5%. The healthcare system achieved 60% of their target goal in one year. The total knowledge rating of the pre test showed a mean score of 10.8 and post intervention 13.8. The matched pairs t-test revealed the post test knowledge scores (t(11) = -6.8, p <.001).: The large volume of individuals seen in the primary care setting affords a rich opportunity for identifying depression. Current evaluation suggests that the validated PHQ-9 depression-screening tool was effective in the current primary care setting, allowing for purposeful interventions to improve patient outcomes.