Enhancing Detection of Depression in Adolescents: Widespread Adoption of PHQ-9 Screening in Community Based Pediatric Practices

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By age 19, 20% of adolescents between the ages of 13 and 18 will experience a major depressive episode, and 65% of adolescents with depression go unrecognized and undiagnosed. The United States Preventive Services Task Force (USPSTF) has recommended implementation of a validated depression screening tool during well exams and recommends routine annual testing for adolescents in situations where appropriate follow-up care can be administered. Several barriers to screening exist and include disruption of efficient practice operations, difficulty in promoting confidential adolescent care, and a national lack of mental health resources for patients. These barriers were identified by eight primary care pediatric practices in SE Pennsylvania resulting in poor compliance with USPSTF recommendations for screening. Initiated in January 2018, the aim of the project was to have 100% of the eight practices using a PHQ-9 by May 2018 with a goal of screening 85% of adolescents by August 2018. Screening was conducted during annual well exams for adolescents 13 through 18 years of age. The results showed that in each practice site, there was rapid adoption with subsequent improvement following the PDSA cycles. All clinical sites met the goal screening rate of 85% of eligible patients by August 2018 and ongoing evaluation in 2019 showed persistence of these screening rates in seven of the eight practice sites. The use of transparent data sharing was credited with team accountability, adoption of the screening program, and culture shift leading to long-term adherence to depression screening. Strong leadership support, local champion involvement, and opportunity to share office-specific implementation strategies are credited with the success of this quality improvement project.



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