Detecting Anxiety in Adults: A Screening and Specialist Referral Protocol for Generalized Anxiety Disorder in Primary Care Setting

BACKGROUND: Generalized anxiety disorder (GAD) is a prevalent condition among adults, but the identification of GAD symptoms in primary care settings is often limited. Once diagnosed, effective treatments are available. In the United States, GAD affects 2.9% of adults in the general population and is frequently seen in primary care.

LOCAL PROBLEM: There were no clear protocols for screening GAD among underserved adults at the project site. Frequent documentation of anxiety by providers highlighted the need for a standardized screening process. The aim was to screen 60% of new patients visiting the clinic for routine and annual physicals, and 50% of those who score positively would be evaluated by the provider and receive resources and referrals by March 2025.

METHODS: The Evidence-Based Practice Improvement (EBPI) model guided the development and implementation of a 3-month screening protocol for adults.

INTERVENTIONS: The Generalized Anxiety Disorder-7 item scale (GAD-7) was completed by patients aged 18 and older. Providers reviewed the positive scores and, based on a referral list in the protocol, nurses would need to schedule appointments at a mental health clinic.

RESULTS: 73 (17.38%) adults were screened from early April to August 2025. The smaller population was due to many Spanish-speaking patients who could not be screened. Providers' adherence to the protocol was a significant challenge. 0 (0%) received a referral. 44 (60.3%) scored minimal to mild, and 29 (39.7%) moderate to severe. 20 (27.4%) started new GAD medication. 9 (12.3%) with moderate-to-severe scores did not receive treatment mainly due to cultural influence.

CONCLUSIONS: While the project did not meet all aims, it helped identify and assess patients with anxiety. No referrals to mental health clinics were made as providers chose to treat patients once anxiety symptoms were identified. The project's sustainability can be achieved by better securing stakeholder interest in future quality improvement initiatives.