Background: Depression is the most common symptom in Multiple Sclerosis (MS) patients with reported lifetime prevalence of 25-50%. Undetected and untreated depression with MS patients have been associated with poor psycho-social and treatment outcomes. Time constraints in ambulatory clinic settings can impact a providers ability to perform a thorough psychological as well as physical evaluation. To address this gap, a neuroscience nurse practitioner (NP) has identified an opportunity to improve clinical practice with the implementation of a standardized depression screening tool.
The objective of this quality improvement project was to implement and evaluate the effectiveness of a Depression Screening Program in adult MS patients using the Patient Health Questionnaire (PHQ-9) screening tool which assists providers with routine screening for depression and provides brief interventions and referrals as warranted.
Methods: The tool was implemented over a 13-week period in an Ambulatory Neurology Clinic located in a mid-Atlantic, urban University Medical Centers. The primary outcomes measures were MS providers and Medical Assistants (MAs) compliance with implementing the PHQ-9 screening tool to identify, treat, and make referrals to mental health providers when needed. MAs completed the PHQ-9 with patients during telemedicine visits. The MS providers reviewed and provided brief intervention if warranted. The Run Chart was used to see the trends over the course of the project implementation and shared with the team.
Results: Of 149 chart audits performed, the PHQ-9 tool was utilized for depression screening in 144 patients in the 13-week period (97% compliance). Of the 144 patients screened, 50% (n=72) were positive for depression, 100% (n= 144) PHQ-9 scores were discussed and reviewed by an MS provider, 27.7% of the patients were started antidepressant by an MS provider,12.5% of the patients were referred to mental health provider. 59.72% (n=43) of the patients were screened as having mild depression, 27.77% (n=20) of the patients had moderate depression, and 12.5% (n=9) of the patients had severe depression. One patient had suicidal ideation, necessitating an urgent transfer to the emergency department (ED). One patient had suicidal ideation, necessitating an urgent transfer to the emergency department (ED).
Depression screening using the PHQ-9 tool is a cost-effective, and time-efficient approach to identifying depression in adult MS patients and ensuring subsequent treatment or referral to mental providers. Early detection, treatment or referral of adult MS patients may help prevent ED visit or hospitalizations and will improve the quality of life for these patients.