Identifying Risk and Improving Outcomes: Application of the GAD-7 Screening Tool Used Among Patients with Chronic Pain in an Outpatient Setting

Background: It is estimated that chronic pain affects one in every five adults and that one in every three adults will be diagnosed with an anxiety disorder within their lifetime, indicating an overlap in both chronic pain and anxiety. Early identification of anxiety in the outpatient setting has the potential to increase identification and referral rates to specialized care.

Local Problem: An outpatient primary care facility that treats patients with chronic pain located in Philadelphia, Pennsylvania was the project setting. Prior to implementation, there was no standard process for identifying anxiety in patients.

Methods: The Iowa model of Evidence-Based Practice was the guiding framework for this project. Demographic data from participants with chronic pain was collected. Data gathered regarding GAD symptoms included the seven questions that comprise the GAD-7 screening tool and if the patient had a previous diagnosis of anxiety.

Intervention: Use of the GAD-7 screening tool on adults in an outpatient setting who are diagnosed with a chronic pain. Individuals with a cut-off score of 8 or higher on the GAD-7 and not presently receiving treatment for anxiety symptoms were referred to a psychiatric specialist.

Results: Of the participants identified with a GAD-7 score of 8 or higher (50%) and who were not already receiving psychiatric treatment for anxiety (13%), all participants not previously receiving treatment for anxiety were referred accordingly.

Conclusion: Implementing the GAD-7 screening tool resulted in a significant increase in identification and specialized psychiatric referral regarding generalized anxiety disorder symptoms in individuals with chronic pain.