Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA


Background: Depressive disorders are a major contributor to disability in the United States and worldwide. They are associated with multiple comorbid conditions including cardiovascular disease, obesity, stroke, and premature mortality. In the US, only 4.2% of primary care patients are being screened for depression and approximately 50% of cases of major depression are being missed.

Purpose: Implementation of a nurse practitioner-led educational intervention, discussing when, why, and how to screen utilizing the PHQ-2 and PHQ-9 screening tools, with the medical assistant staff in order to increase compliance with annual screening.

EBP Model/Frameworks: The Iowa model was used to guide implementation of this project (Iowa Model Collaborative et al., 2017).

Evidence-Based Interventions: Evidence-based interventions include education to medical assistant (MA) staff on administration of the PHQ-2 during check-in and subsequent PHQ-9 administration for PHQ-2 scores ≥3, and practitioner review of PHQ-9 scores with patients.

Evaluations/Results: Evaluation of results of this project included an increase in the number of patients screened during well visits from 72% to 83%, resulting in a significantly lower number of persons not screened, (x2 = 8.91, p = 0.003).

Implications for Practice: In 2010, $80,377 billion were spent in the US on major depressive disorder. With increased screening and treatment in the primary care setting, unnecessary costs of undiagnosed depression can be avoided, saving approximately $38,101 billion per year. The implementation of a one-time MA educational in-service can increase compliance with screening at well visits. Annual screening helps establish a long-term relationship between patient and provider where patients feel that all their needs are being met.

Conclusion: Standardizing the screening for unmanaged depressive symptoms can be incorporated into the check-in process. While these primary care practitioners at levels higher than the national average (72% vs 4.2%), the implementation of MA education/training for PHQ-2/PHQ-9 assessment during the check-in process significantly increased the number of patients screened at annual well visits. Through increased screening practitioners are able to diagnose patients sooner, provide necessary resources and increase quality of life.