Enhancing Follow-Up Care: Implementing Routine Depression Screenings in Primary Care Visits

BACKGROUND: Depression is a prevalent mental health condition, often underdiagnosed in rural areas such as Appalachia, where access to behavioral health services is limited. National guidelines from the United States Preventative Services Task Force recommend routine depression screenings for adults; however, inconsistent implementation in primary care may delay diagnosis and treatment. The PHQ-9 tool has been proven effective for early detection of depression and improving patient outcomes when routinely applied in clinical settings.

LOCAL PROBLEM: A rural primary care clinic in East Tennessee lacked a standardized process for administering the PHQ-9 during follow-up visits, resulting in missed opportunities to detect worsening or newly developed depression. Although new patients were routinely screened, follow-up assessments were inconsistently performed. The purpose of this project was to implement a routine PHQ-9 screening process during follow-up appointments to improve early depression identification, increase access to community resources, and improve timely, appropriate referrals.

METHODS: The Johns Hopkins Evidence-Based Practice Model guided project implementation. Retrospective baseline data on PHQ-9 usage and referrals were collected. Interventions were developed using evidence-based literature, staff input, and tested through PDSA cycles. Data was analyzed using Microsoft Excel to evaluate changes in screening rates and referrals.

INTERVENTIONS: The intervention included PHQ-9 form distribution throughout the clinic, an educational session, and later integration of the PHQ-9 into the EMR following low initial compliance. Ongoing staff training and workflow adjustments supported sustained practice change.

RESULTS: Screening compliance increased from 49% to 93.5%. A statistically significant improvement in screening was observed (p < 0.001). There were 29 total referrals during implementation compared to 3 total referrals in retrospective data collection.

CONCLUSIONS: Routine PHQ-9 screening improved depression detection and mental health referrals. Continued staff training, EMR prompts, and expansion to other clinic sites are recommended for sustainability and broader impact.