Overcoming Barriers to Implement Depression Screening Post-Stroke

Abstract

Background

One-third of all stroke survivors are expected to develop post-stroke depression, which is linked to lower quality of life, impaired recovery, increased risk of recurrence and an overall increase in mortality (Robinson & Jorge, 2015).

Objectives

Despite this link, outpatient clinics including the stroke clinic of focus do not consistently use a formal depression screen. Therefore, a pilot project utilizing the framework of the IOWA Model of Evidence Based Practice to implement this American Stroke Association recommended guideline may result in a permanent adoption of screening (Iowa Model Collaborative, 2017).

Purpose

The purpose of this evidence-based practice project was to implement depression screening through (1) the identification of barriers driving the absence of routine depression screening and (2) address those barriers prior to completing a 6-week pilot study.

Methods

The project consisted of an extensive literature review and selection of the Patient Health Questionnaire-9 (PHQ-9) as the most appropriate screening instrument. The barriers to routine depression screening were identified as limited clinician time and limited clinician knowledge. Office efficiency was addressed by having the office registered nurse administer the PHQ-9 to patients. Provider education was completed using an 8-minute informational video module that included pre and post-survey knowledge-based questions as well as a post-pilot survey to evaluate provider perceptions of post-stroke depression screening.

Results

The clinic screened 45 eligible patients for the pilot, with no patients declining screening. Concern for significant markers of depression were identified in 17.8% of patients. Provider perception of the pilot screening was positive, with all providers agreeing that the PHQ-9 was an efficient tool, that depression screening was important to patient care, and that the overall project increased their knowledge of post-stroke depression. The clinic providers adopted routine screening as part of the outpatient follow-up on a continuous basis following the pilot.

Conclusions

Significant barriers to identifying post-stroke depression are common. Increasing provider education and selecting efficient tools and methods for screening may help overcome barriers to successfully implementing routine depression screening in the outpatient setting.