Leveraging the Annual Wellness Visit to Improve Rural Depression Management


  • Emily Sundeen University of South Alabama
  • Warseal Powell University of South Alabama
  • Robert Deuell Hunt Regional Medical Partners




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.

DOI:  http://dx.doi.org/10.14574/ojrnhc.v20i1.602  

Keywords: depression, screening, preventive services, Patient Health Questionnaire-9, annual wellness visit.

Author Biographies

Emily Sundeen, University of South Alabama


Family Nurse Practitioner, Hunt Memorial Hospital District and Hunt Regional Medical Partners 

Warseal Powell, University of South Alabama


Assistant Professor, University of South Alabama School of Nursing

Robert Deuell, Hunt Regional Medical Partners

Robert Deuell, M.D.

Medical Director, Hunt Regional Medical Partners