Depression in Diabetes: Utilizing a Depression Management Algorithm in Primary Care

Thumbnail Image
Throneburg, Cynthia
Issue Date
Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Quality Improvement , Diabetes Mellitus, Type 2 , Depression , Patient Health Questionnaire
Background: Patients with diabetes are more prone to depression because of the debilitating nature of coping with a chronic disease long term (Polacsek et al., 2021). Screening for depression in this population is critical and should be done to meet standards of care for patients with diabetes that are recommended by the United States Preventative Service Task Force (USPSTF) and the American Diabetes Association (ADA). There are a number of screening tools available with the Patient Health Questionnaire-9 (PHQ-9) screening tool for depression being one that is evidence-based and widely utilized (Owens-Gary et al., 2018). Objective: The primary objective of this quality improvement (QI) project was to increase screening, education, and referrals for depression in patients concurrently diagnosed with Type 2 diabetes (T2DM), using the PHQ-9. The secondary objective was to increase provider confidence in utilizing the PHQ-9 to screen for depression in patients with T2DM. Methods: Healthcare providers who are treating patients diagnosed with diabetes in a primary care practice will be the primary population. The principal investigator (PI) will track all patients diagnosed with diabetes seen by the participants and screen for use of the Patient Health Questionnaire-9 (PHQ-9) to screen for depression. Comparative data was collected using a retrospective chart review to collect pre- intervention depression screening for adult patients with T2DM over a three-month period. The goal of the QI project was to increase depression screening with utilization of the PHQ-9. Results: The chi-square test of independence revealed statistically significant increases in depression screening (72.42, p < .001), education (52.56, p <.001), and referrals (6.0, p <.014) of patients with Type 2 diabetes with implementation of the CCNC Depression Management Algorithm and PHQ-9 screening tool. The PHQ-9 results revealed that nearly 40% of the patients screened had some level of depression. The provider’s confidence level in utilizing the PHQ-9 survey increased in all six categories assessed in the provider confidence survey. Conclusions: Implementation of the PHQ-9 instrument to screen for depression was successful and sustainable in increasing the number of patients with Type 2 diabetes screened, educated, and referred.