Evidence-Based Interventions To Address Gaps In Practice Assignment

Evidence-Based Interventions To Address Gaps In Practice Assignment

The initiation of improvements in the process of depression screening at the primary care level using the PHQ-9 can be achieved with primary care physicians and clinical staff. A quality improvement initiative to improve depression screening in underserved populations demonstrated that barriers to PHQ- 9 implementation include failure to prioritize depression as a clinical problem, requirement for staff to perform screenings, inadequate knowledge about depression screening and management among providers, and lack of appropriate tools for documentation of PHQ-9 results (Henry et al., 2021)Evidence-Based Interventions To Address Gaps In Practice Assignment.

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Measurement based care is an EBP that involves the routine utilization of standardized results, that is, PHQ-9 for depression severity to guide clinicians on decision-making about psychotherapy. A study by Lewis et al. (2018) demonstrated that the standardized method is the best practices approach to the implementation of PHQ-9 and it incorporates distinct implementation strategies:  electronic health record enhancements; a needs assessment; training; and MBC   guidelines.  The PHQ-9 questions were entrenched in the EHR to permit providers to transfer patients’ scores from paper to their electronic chats. The EHR computed t total PHQ-9 scores and generated symptom trajectories over tie Evidence-Based Interventions To Address Gaps In Practice Assignment.

Regarding needs assessment, all clinicians completed a self-report to divulge contextual influencing factors, with the results being used in characterizing clinics but not informing the process of implementation. Clinicians attended a four-hour training one month following the needs assessment. The major goals were introducing clinicians to the PHQ-9 and building foundational skills and knowledge regarding the three central components: administration of the PH-9; reviewing of score graphs, and discussing the scores with the client. There was a discussion of the recommended guideline to implement MBC during the training and all through the consultation meetings.  Available literature ( for example, stating that providers should administer, review and discuss the PHQ-9 with adult clients with depression at the start of each session)  informed the guideline (Lewis et al., 2018)Evidence-Based Interventions To Address Gaps In Practice Assignment.

Clinical decision support (CDS) with the HER is an evidence-based strategy for improving the screening and management of depression with the utilization of the PHQ-9. The study by Maten et al. (2021) aimed at comparing implementation outcomes of two versions of a CDS tool to improve the administration of PHQ-9 for depressed patients.  Both versions aimed at increasing the administration of PHQ-9 and documentation of score when there was an increase in the most recent PHQ-score and there was a clinical indication of PHQ-9. Version 1 was designed as an active CDS that would distract clinicians every time they opened a patient’s clinical encounter whose recent PHQ-9 was equal to or greater than 9 and the last alert was g equal to or more than three months ago. The reminder that appeared recommended PHQ-9 administration and offered eight response options including the option to indicate the PHQ-9 was inappropriate and the option to update the PHQ-9 score. Version 2 was a passive CDS  tool that did not disrupt workflow, but was available upon clinicians’ demand. The passive CDS was available all through the patient encounter and permitted access to the information at the discretion of the clinician. The study demonstrates that CDS reminders are likely to improve the frequency of PH-9 administration. An interruptive CDS tool. might be more effective at increasing administration of PHQ-9, but a noninterruptive  CDS tool might be favorable for decreasing alert fatigue although it is less effective(Maten et a;l., 2021)Evidence-Based Interventions To Address Gaps In Practice Assignment.

The project by Henry et al. (2021) demonstrated that EMR alerts helped in identifying patients who had received depression screening and also patients with positive depression screening.  Additionally, referral options and treatment guidelines in the EMR made it possible for providers to link patients with resources. There was a significant rise in depression screening with the PHQ-9  in the first six months of the project. There was the identification of around 20 percent of patients with positive depression screening and all of them were referred to mental health providers for further evaluation and follow-up(Henry et al., 2021)Evidence-Based Interventions To Address Gaps In Practice Assignment.

References

Henry, T. L., Schmidt, S., Lund, M. B., Haynes, T., Ford, D., Egwuogu, H., Schimtz, S., McGregor, B., Toomer, L., & Bussey-Jones. (2019). Improving Depression Screening in
Underserved Populations in a Large Urban Academic Primary Care Center: A Provider-Centered Analysis and Approach. American Journal of Medical Quality, 35(4), 1-8. DOI: 10.1177/1062860619884639

Lewis, C. C., Puspitasari, A., Boyd, M. R., Scott, K., Mariot, B. R., Hoffman, M., Navarro, E., & Kassab, H. (2018). Implementing measurement based care in community mental health: a description of tailored and standardized methods. BMC Research Notes, 11, 76. https://doi.org/10.1186/s13104-018-3193-0

Maten, N., Kroehl, M. E., Loeb, D. F., Bhat, S., Ota, T., Billups, S. J., Schillimg, L. M. (2021).  An evaluation of clinical decision support tools for Patient Health Questionnaire-9 administration. Mental Health Clinician, 11(5), 267-273. doi: 10.9740/mhc.2021.09.267 Evidence-Based Interventions To Address Gaps In Practice Assignment

Discussion

Purpose

The purpose of this assignment is to examine an evidence-based intervention, which will serve as the mechanism for the development of the DNP practice change project.

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Instructions

Reflect on your readings this week and respond to the following:

1. Identify and explain your proposed DNP practice change project evidence-based intervention most commonly found in your literature search.
2. Provide three (3) scholarly sources that support this evidence-based intervention as a solution to your identified practice problem.

DNP practice change project is : Diagnosing Major Depressive Disorder utilizing PHQ – 9 tool leading to improved diagnosis, treatment, and monitoring Evidence-Based Interventions To Address Gaps In Practice Assignment