Leveraging the Annual Wellness Visit to Improve Rural Depression Management
Purpose: Depression is a common condition in rural primary care associated with significant adverse health and quality of life outcomes. Despite evidence-based practice recommendations, depression screening and follow-up are inconsistent in practice. The purpose of this quality improvement project was to improve the rate of depression screening and management as a component of the Annual Wellness Visit (AWV) in the rural, primary care setting. The overarching project aim was to increase the rate of depression screening and treatment in adult Medicare patients by 50% through the implementation of a standardized screening instrument and management plan within eight weeks of project implementation.
Sample: The sample population included 66 Medicare beneficiaries receiving a Medicare Annual Wellness Visit at a primary care practice in rural Northeast Texas.
Method: The central focus of this quality improvement project was to initiate standardized depression screening and management in the Medicare population as a component of the annual wellness visit. Patients were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) instrument. An evidence-based depression management plan based on the PHQ-9 score guided follow-up and management.
Findings: When depression screening was performed as a component of the AWV, 98.5% of patients received depression screening with a validated instrument. 73.3% of patients who had a PHQ-9 score of five or greater had a documented follow-up plan, and 93.3% had recommended treatment initiated. A strong positive correlation was found among patients who screened positive for depression and received a documented follow-up plan (rho (63) = .993, p <.001) and had treatment plan initiated (rho (63) = .998, p <.001).
Conclusions: Implementing standardized workflows, such as the annual wellness visit, is foundational to consistently identify and treat depression to remission in the rural primary care setting.
Keywords: depression, screening, preventive services, Patient Health Questionnaire-9, annual wellness visit.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share (for non-commerical purposes) the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).