Primary Care Commons^™

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

Covid-19 And Depression And Anxiety Screening In Primary Care, Elizabeth Bernier, Abrey Feliccia, Leah Wood, Kate Herlihy, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Introduction:

• The COVID-19 pandemic had a severe effect on mental health, heightening the prevalence and severity of anxiety and depression amongst the general population in rural and non-rural areas, particularly youth.

• Most reports draw from available data from mental health referrals, hospitalizations, suicides, and other incident data

• There is limited longitudinal information from general population samples using standardized mental health assessments.

Improving Depression Screening Protocol And Subsequent Sbirt Referrals, Mclaine S. Rich

Family Medicine Clerkship Student Projects

As a federally qualified health center, Lamoille Health Family Medicine receives annual data evaluating their performance in a number of categories. They exceeded expectations in screening eligible patients for depression, yet did not see the same success in referrals following a positive screening. After discussing with nursing and physician staff it became clear that there were discrepancies regarding office workflow/specific responsibilities. Moreover, some physicians expressed that they were unsure exactly how to handle positive screening results. This flowsheet developed will alleviate confusion in who is responsible for each step of screening, and uses evidence based guidelines for when to refer …

Depression Management Among Primary Care Providers: Evaluation Of An Educational Intervention, Whitney Hunt

DNP Projects

Background: Nearly one-third of patients diagnosed with depression and prescribed an antidepressant medication will stop taking their medication within the first month. Timely follow-up care can improve medication adherence and symptoms for depressed patients on antidepressants however, most patients do not receive timely follow-up. Common system and provider-based barriers to timely follow-up include limited provider time, lack of training, and mental health stigma.

Objective: The purpose of this project was to assess provider attitudes, knowledge level, perceived barriers, and current depression management strategies in a primary care setting.

Methods: In this quasi-experimental one group pre/post-test study a survey was used …

Is There An App For That? Introducing Self-Guided Therapy-Based Mental Health Apps In A Primary Care Setting, Althea Jem Darbin Tapales

Family Medicine Clerkship Student Projects

The prevalence of mental health disorders in Vermont continues to be an economic burden, especially in Addison County. The Addison County, VT Community Health Improvement Plan 2022-2025 identified “Access to Mental Health Services” as the top priority with a general concern regarding the affordability and demand of such services, and shortage of providers in the general community. Consequently, the shortage of mental health services along with the coronavirus pandemic resulted in a mental illness epidemic which led to an accelerated growth of self-guided therapy-based mental health apps. Most apps are affordable, accessible, and prioritize patient privacy which overcomes barriers to …

Bridging Cultural Barriers To Perinatal Mental Health Care In New Americans, Madeline Yvette Powell

Family Medicine Clerkship Student Projects

Perinatal mental health outcomes are worse in New Americans, particularly in refugee patients. Mental health stigma and cultural differences in views on mental illness impact New Americans’ willingness to discuss mental health concerns with healthcare workers. This is in addition to language barriers, time constraints, financial barriers, and general mistrust of medical professionals.

Investigating The Relationship Between Mental Health And Co- Morbidity Management During The Covid-19 Pandemic: A Literature Review, Alejandra Soto

Theses and Graduate Projects

Background: The COVID-19 pandemic caused many disruptions to millions of lives, especially with the enforcement of government shutdowns, isolations, and social distancing. These measures lead to increased anxiety and depression in the general population. With many high- risk patient populations having chronic comorbidities, accessing routine medical care and supplies became difficult during the pandemic.

Purpose: How has mental health affected the management of pre-existing comorbidities during the COVID-19 pandemic?

Methods: A comprehensive literature review was conducted using the research engine PubMed using the search terms: “pandemic”, “COVID-19”, “comorbidities”, “mental health”, “morbidity”, and “mortality”. Inclusion criteria were studies …

Addressing Post –Covid-19 Pandemic Depression, Aria Elahi

Family Medicine Clerkship Student Projects

This community project explores the impact of the COVID-19 pandemic on mental health, particularly focusing on depression, and introduces an intervention in the form of a pamphlet distributed at Newtown Primary Care. The pamphlet addresses individuals experiencing worsened depression due to the pandemic, regardless of COVID-19 infection status, and includes the PHQ-2 and PHQ-9 screening questionnaires for self-assessment. Insights from interviews with Newtown Primary Care were instrumental in designing the pamphlet.

Results reveal that the pandemic has substantially affected patients' mental health, increasing the need for resources. Patients diagnosed with pre-existing depression experienced worsening symptoms due increased stressors due to …

Depression In Black Men: Disparities In Diagnosis And Treatment, Amy Nwaobasi, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Review epidemiology
• Review risk factors and protective factors that are associated with depression in black men
• Understand causes of disparities in diagnosis
• Understand barriers to treatments
• Explore ways physicians can address these disparities

The Effect Of Implementing A Generalized Anxiety Disorder Protocol For Anxiety And Depression Symptoms In The Primary Care Setting, Bailey J. Hinman

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is very prevalent in the United States with 5.7% of citizens affected (National Institute of Mental Health [NIMH], 2017). This number is expected to be even higher because individuals avoid care due to stigma of mental illness (Andrews et al., 2018). GAD can have significant implications such as decreased ability to function, decreased quality of life and increased risk of suicide (Fong, 2018; Lizarondo, 2018). The purpose of this project was to improve outcomes for adult patients with GAD in the primary care setting by improving treatment to follow best practice recommendations. The Johns Hopkins Evidence …

The Role Of Primary Care Physicians In Post-Partum Depression (Ppd), Elizabeth Bowman

Rowan-Virtua Research Day

Background

• Symptoms of depression lasting longer than 2 weeks following birth
• 10-15% of new mothers affected yet 50% of cases go undiagnosed
• Long-lasting consequences for the mother, baby, and father
• Multi-factorial condition

Conclusion

• Primary care providers are the first-line defense against PPD
• Many providers are resistant to PPD screenings
• Interventions from primary care providers are effective

Addressing Psychosocial Outcomes Of Social Isolation In Older Adults, Megan Friesen, Madeline M. Christensen

Nursing DNP Projects

Purpose and Rationale

The aim of the evidence-based practice (EBP) project is to improve psychological outcomes for socially isolated older adults enrolled in a Homebound Program (HP) through the implementation of an EBP intervention. Social isolation has a multitude of negative consequences, including impacting the psychological health (e.g. depression, loneliness, anxiety) of the older adult population.

Synthesis of Evidence

Meta-analyses, systematic reviews, and randomized controlled trials addressing the clinical problem of social isolation were identified. Through critical appraisal of the evidence, physical activity, psychotherapy, and socialization interventions have shown to decrease depression and loneliness in older adults. There were mixed …

Exercise As A Tool For Treating Anxiety And Depression, Lizzi Hahn

Family Medicine Clerkship Student Projects

In addition to its important role in the maintenance of physical health, exercise has been shown to have numerous benefits for mental health. Recent studies indicate that even brief engagement in physical activity can make a positive impact on the treatment of pre-existing anxiety and depression - as well as the prevention of future symptoms. Despite this relationship between exercise and emotional wellness, regular activity in the United States is still exceedingly low, and exercise remains an underused tool by healthcare providers in the treatment of their patients’ anxiety and depression. The goal of this project was to assess patient …

Opportunities For Patient Self-Reflection During Acute Phase Of Depression Treatment, Millen Abselab

Family Medicine Clerkship Student Projects

This project for UVMMC Family Medicine at Hinesburg investigates the acute phase of depression treatment for adult patients and introduces opportunities for patient empowerment during this 4-to-6-week window through de-identified automated text surveys for self-reflection about treatment and pattern tracking contributory to mood. Sample text survey built on Beck Depression Inventory (BDI-II) and deployment of text surveys is based on Mosio. Future interventions can utilize mobile phone apps based on patient response to surveys.

Community Resources Addressing Peripartum Depression, Tiffany L. Lao

Family Medicine Clerkship Student Projects

Peripartum mood disorders affect a large proportion of new mothers as well as their families, partners, and support systems. This project aims to provide patients with information about peripartum mood disorders as part of their initial prenatal packet. Also included are a list of local community resources specifically addressing peripartum mood disorders for patients seeking additional support outside of their primary care office.

Devoloping A Primary Care Screening Protocol For Post-Miscarriage Depression, Sean Muniz

Family Medicine Clerkship Student Projects

Spontaneous abortions occur in 20-33% of pregnancies, and 10-30% of these women have clinically significant depression. These women are often unscreened by either PCPs or OBs for depressive symptoms. We developed a screening protocol using the PHQ-2 to assess for depression in patients who have had a spontaneous abortion. The protocol utilizes a nursing care manager to follow up with patients who either were seen in the ED or self report spontaneous abortions to the PCP office. Follow up phone calls should be made within 2 weeks and at 6 weeks post spontaneous abortion, with offers for in-person follow-up given …

The Use Of Technology For Mental Wellbeing In The Era Of Covid-19, Adam Fakhri

Family Medicine Clerkship Student Projects

Prevalence of mental health issues has increased during the time of COVID-19. There are many contributing factors to consider, the main one reported has been social isolation due to quarantine precautions. Members of the community have spent extended periods of time at home and away from their loved ones during this pandemic. Many patients have reported many life events occurring including deaths in the family without the ability to even mourn with their family members. This has taken a toll on the community, especially in Vergennes where this small tight knit community that has relied on its tight social bonds …

Mental Health Technology During The Era Of Covid-19, Michael Tabet

Family Medicine Clerkship Student Projects

Mental health symptoms - especially those of depression and anxiety - have become more prevalent during the COVID pandemic. As seen in previous years, direct and indirect costs of depression can be staggering. Apps exist on smart devices that are based in evidence-based practices that can be therapeutic for mental health issues such as depression, anxiety, and insomnia. A simple handout with some suggested popular mental health apps and accompanying descriptions was created to be used in the CVPH Family Medicine clinic to increase awareness of these apps among patients suffering from depression, anxiety, and insomnia.

Depression In Primary Care: With A Focus On First-Line Medications, Michael Danielewicz, Md

Department of Family & Community Medicine Presentations and Grand Rounds

This Lecture Will Cover:

• An overview of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), bupropion and mirtazapine
• Appropriate selection and dose adjustments of first-line agents for depressive disorders in a primary care setting
• Monitoring and tapering first-line antidepressants
• Special considerations in treatment
• Future directions for antidepressant treatment

A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

The Effect Of The Screening, Brief Intervention, Referral To Treatment (Sbirt) Model On Adult Depression In An Outpatient Setting, Genevieve E. Sweeney

Doctoral Projects

Depression is one of the most common chronic conditions in the world. Despite this, depression continues to be under-screened, inaccurately assessed and diagnosed, and poorly treated in outpatient settings. Many providers solely rely on clinical judgement instead of a screening tool or evidence-based toolkit when a patient presents with depression symptoms, resulting in underdiagnosis and inappropriate treatment. Utilization of resources can help a provider appropriately screen, diagnose and treat an individual with depression. Screening, Brief Intervention, Referral to Treatment (SBIRT) is an evidence-based model intended to improve these measures. Studies from the literature support the efficacy of the SBIRT model …

Phq-9, But In Spanish, Jose Calderon

Family Medicine Clerkship Student Projects

Spanish speaking patients are often missed for depression. A common issue is lack of awareness of the Spanish version of the PHQ-9

Resource To Address Pandemic-Related Anxiety And Depression For Pregnant Patients In Vermont, Mohammed Wali

Family Medicine Clerkship Student Projects

The 2019 novel coronavirus (COVID-19) has led to patient deaths, strained health care systems, and economic uncertainty. Distress during pregnancy can lead to adverse outcomes for both parent and baby. A patient-friendly handout was created for pregnant patients to offer reassurance, incorporate mind-body recommendations to address stress, and offer screening tools to empower them to address mood concerns with their obstetric providers in the COVID-era.

Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer

Family Medicine Clerkship Student Projects

This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.

Pilot Study Of Behavioral Activation As Adjunct Treatment For Depression In Primary Care, Lindsay Ellen Toler

Graduate Theses, Dissertations, and Problem Reports

Many individuals receiving care at a predominantly free primary health care clinic in the northern part of West Virginia are experiencing depression, and medication therapy is the most common form of management with limited resources for psychosocial treatment. Brief psychosocial therapy interventions provided by the primary care provider should be explored as an adjunct treatment for this population in the primary care setting.

A pilot study was conducted to explore the integration of behavioral activation, a brief psychosocial intervention focused on decreasing depressed behavior by increasing nondepressed behavior to reinforce corresponding improvements in mood. Eligible patients were invited to attend …

Coping Skills For Daily Life: Cost-Effective Strategies To Prevent And Address Mental Health Disorders, Shae Ian Rowlandson

Family Medicine Clerkship Student Projects

Mental health disorders, along with their associated cost and negative outcomes, have continued to persist in Vermont and have become one of the largest, growing challenges to public health in the United States. Unfortunately, Vermont does not appear to have enough resources or providers to optimally address it. Concurrently, coping strategies of minimal cost that have the potential to prevent or address mental health disorders may often be underutilized or misconstrued by the population. A pamphlet providing information on evidenced, cost-effective coping strategies was designed and distributed to providers and patients to enable patients with the skills to help themselves …

Patient Education On The Association Of Hormonal Contraception With Depression, Julia E. Hannigan

Family Medicine Clerkship Student Projects

Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.

Exercise Promotion For Patients With Mental Health Conditions In Milton, Vt, Pirapon Leo Chaidarun

Family Medicine Clerkship Student Projects

Depression and anxiety are two highly prevalent mental health conditions and can often occur together. Research shows that sustained low-intensity exercise releases chemicals that promote nerve cell growth in the brain, which helps regulate mood and relieve symptoms. Exercise may seem like a logical solution for mental health to those with a medical background, but may be a new idea to many patients who are unaware of the added benefits of staying active.

Meditation For Depression And Anxiety, Max Knapp

Family Medicine Clerkship Student Projects

Mental health is a major burden on residents of Vermont. Access to care is the most commonly cited cause. An evidence-based pamphlet was designed to empower providers to quickly and easily help patients start a meditation practice to help address such concerns.

Caregiver Burnout, Elizabeth Anne Lynch

Family Medicine Clerkship Student Projects

Caring for someone with advanced health care needs, dementia, or a difficult diagnosis can take a mental, physical and financial toll on the caregiver. It is important for providers to recognize, address and assist caregivers in as many ways as possible. Providing physicians with a readily available patient-education template in Epic may improve outreach and communication with increasingly isolated patients and caregivers and improve care for all without burdening physicians more.