Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)
Document Type
Poster
Publication Date
7-29-2024
Abstract
Abstract
Background: One in five rural residents experience anxiety. Specialty mental health services are often scarce in these communities, leading primary care providers (PCPs) to manage and treat these symptoms. This poses barriers to care, such as time constraints that delay the identification of generalized anxiety disorder (GAD) and referrals to mental health services.
Local Problem: This project aimed to address this high prevalence of anxiety among patients at a Tennessee primary care clinic without a GAD screening and referral process. The GAD Screening and Specialty Referral Toolkit was created with the aim to screen 60% of patients presenting for anxiety or a wellness check, with 40% of those patients screened positive receiving a mental health referral.
Methods: The Model for Improvement and Plan-Do-Study-Act cycles were used as the guiding framework to accelerate this quality improvement project. The GAD Screening 7-item (GAD-7) was the standardized diagnostic instrument to detect and assess the severity of GAD symptoms. Measures included pre- and post-implementation assessment of screening and specialty referral rates.
Interventions: The Significant Health History Questionnaire (SHHQ), specifically developed for this project, was integrated to enhance the promptness of care. Patients flagged as at-risk through the SHHQ received the GAD-7; those with positive GAD-7 results (score ≥ 8) were evaluated and received a referral to mental health services. Results: Out of 419 patients screened, 152 (36.3%) identified as at risk; 93.5% (N=143) of them completed the GAD-7 screening. Among those who tested positive on the GAD-7, 77.8% (N=82) received a mental health referral. 14.4% (N=15) of referred patients declined the referral.
Conclusion: Implementing the GAD Screening and Referral Toolkit improved GAD identification and equipped PCPs with specialty mental health resources. Given the clinical significance of this improved process in facilitating effective anxiety treatment planning, the project site aims to sustain and expand its use to every patient visit.
Recommended Citation
Halliday, Sydney L.; Mills, Jeremy; and Vasilik, Ashley, "Improving Mental Health Access Through Primary Care: Implementation of a Generalized Anxiety Disorder Screening and Specialist Referral Protocol" (2024). Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP).
https://trace.tennessee.edu/dnp/126
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Community Health and Preventive Medicine Commons, Family Practice Nursing Commons, Psychiatric and Mental Health Commons, Quality Improvement Commons