Implementing a standardized mental health screening protocol in a primary care setting

Abstract

Aim: Facilitate early detection and prompt treatment of anxiety and depression through mental health screening, leading to participant self-awareness and mitigation of potential sequelae (e.g., alcohol abuse, substance abuse, and suicidal ideations). Background: Lack of awareness of ongoing depression or anxiety is a key contributor to not obtaining the medical care needed by patients in a primary care setting. Both providers and patients are unaware of these significant mental health issues, and may benefit from evidence-based initiatives supported by the Substance Abuse and Mental Health Services Administration where the RE-AIM framework was implemented for further guidance. Methods: A mental health screening protocol was implemented in a primary care setting, leading to treatment by the primary care provider or referral to a mental health specialist. Mental health screening protocol included generalized anxiety disorder 7 (GAD7) for detecting anxiety, and patient health questionnaire 8 (PHQ8) for detecting depression. Findings: 24 out of 50 patients screened positive for anxiety or depression and were referred. Of those, 21 adhered to the treatment or referral, with an 87.5% adherence rate, higher than the institutional goal of 40%. 3 remaining patients that did not adhere barely met the cutoff for screening positive, and discussed follow-up visits with their primary care provider. Pearson’s correlational analyses demonstrated an r value of 0.85 between the GAD7 and PHQ8, an r value of 0.84 between the GAD7 and referral adherence, and an r value of 0.91 between the PHQ8 and referral adherence. Statistical significance was noted as p values were <0.001 for all analyses. Conclusions: Improved patient outcomes for patients suffering from anxiety and/or depression are noted in the outpatient primary care setting through mental health screening and provider referrals, and can be applied to virtually any healthcare setting as indicated by the Substance Abuse and Mental Health Services Administration. Implementation of these evidence-based interventions address Healthy People 2030 Social Determinants of Health and mitigation of potential sequelae.