Date of Award

Spring 5-26-2018

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Michael Terry, DNP


Background: Major Depressive Disorder (MDD) affects over 15 million (6.7%) adult Americans. While one in four primary care patients suffer from depressive symptoms, MDD is accurately diagnosed as little as 25% of the time.

Purpose: Implementation of an evidence-based protocol outlining the process for screening, behavioral health referral, and the role of a collaborative care team would improve detection and treatment of adult MDD patients in the ambulatory setting.

Process: A systematic Patient Health Questionnaire (PHQ-9) based screening protocol was implemented. Every new and existing patient completed the PHQ-9 during scheduled primary care appointments. If a patient scored 15 or higher, indicating moderate to severe risk, they were referred to behavioral health. The behavioral health case manager then triaged the patient for their specific needs and scheduled appointments to psychiatry and psychology as appropriate. If a patient was not progressing during treatment the case was discussed during bi-weekly collaborative care team meetings and the plan was adjusted.

Outcomes: The baseline PHQ-9 screening rate for all patients was 40% for Quarter 2 of 2017. After implementation of the protocol screening rates of new and existing patients increased to 49% in one month’s time. After two months screening and referral rates reached 100%. This rate was maintained for the five-month project duration.

Conclusion: Depression must be addressed in the primary care setting. Depression screening is a safe and efficacious intervention to improve detection and guide treatment. Addressing MDD in a collaborative care model is also a cost-effective and successful approach to address one of the most detrimental diseases worldwide.