A quality improvement project to improve mental health screening at nurse triage in a primary healthcare center

Judy Shalin; Sanaulla Sheik; Amit Gupta; Bobby Thomas; Mohammed J. M. Albarbari; Achuth Sreedhar; Annalyn Beraquit Bo

doi:10.18203/2394-6040.ijcmph20262216

Authors

Judy Shalin Al Khor Health Center, Primary Health Care Corporation, Qatar
Sanaulla Sheik Al Khor Health Center, Primary Health Care Corporation, Qatar https://orcid.org/0000-0002-1103-3209
Amit Gupta Al Khor Health Center, Primary Health Care Corporation, Qatar
Bobby Thomas Al Khor Health Center, Primary Health Care Corporation, Qatar
Mohammed J. M. Albarbari Al Khor Health Center, Primary Health Care Corporation, Qatar
Achuth Sreedhar Al Khor Health Center, Primary Health Care Corporation, Qatar
Annalyn Beraquit Bo Al Khor Health Center, Primary Health Care Corporation, Qatar

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20262216

Keywords:

Generalized anxiety disorder, Mental health screening, Patient health questionnaire, Quality improvement project

Abstract

Background: One-fifth of adults attending primary care have a diagnosable mental disorder, which is in top 10 diseases of global burden. Screening for early detection of mental and substance misuse disorders in primary care can improve quality of life. The screening percentage was low at 86% for mental health. So, QI project undertaken to improve mental health triage at health center using a staff reminder strategy and refresher training at individual level, as these have shown effectiveness in systematic reviews.

Methods: The project employed plan-do-study-act (PDSA) cycles to test the change ideas. Quality improvement tools, including process mapping, Fishbone analysis, driver diagrams, and prioritization matrices, were used to identify root causes and develop interventions and refresher training of nurses were the change ideas.

Results: The refresher education session was attended by 42 nurses and 52 nurses received regular emails on update and reminder on first week of each month and weekly social media messages throughout the project period. Mental health triage asking for PHQ2 and GAD2 questionnaire by triage nurses improved significantly during the project period of 3months from the baseline values of 84% to 94% for depression and from 88% to 97% for anxiety.

Conclusions: Mental health triage in primary care health centers can be improved by increasing its awareness in triage nurses and their attitude towards mental health. Mental health screening can be improved by refresher training and reminders. Collaboration and teamwork between nurse and administration team will deliver an excellent outcome.

Author Biography

Sanaulla Sheik, Al Khor Health Center, Primary Health Care Corporation, Qatar

Family Physician,

Primary Health Care Corporation.

References

Royal College of General Practitioners. Royal college of general practitioners position statement: mental health and primary care. London J Prim Care. 2009;2(1):8-14.

Wadoo O, Ahmed MAS, Reagu S, Al Abdulla SA, Al Abdulla MAYA. Primary care mental health services in Qatar. B J Psych Int. 2021;18(1):15-8.

GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatr. 2022;9(2):137-50.

World Health Organization. Integrating mental health into primary care: a global perspective. World Health Organization; 2008.

General Secretariat Supreme Council of Health. National Primary Health Care Strategy 2013-2018. 2013. Available from: https://www.moph.gov.qa/_layouts/download.aspx?SourceUrl=/Admin/Lists/PublicationsAttachments/Attachments/54/NHS.pdf. Accessed on 8 February 2025.

Dragioti E, Radua J, Solmi M, Gosling CJ, Oliver D, Lascialfari F, et al. Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatr. 2023;22(1):86-104.

Cheung A, Weir M, Mayhew A, Kozloff N, Brown K, Grimshaw J. Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev. 2012;1(1):36.

Blackstone SR, Sebring AN, Allen C, Tan JS, Compton R. Improving depression screening in primary care: a quality improvement initiative. J Community Health. 2022;47(3):400-7.

Siu AL, US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-7.

Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439-45.

Berg AO. Screening for depression: recommendations and rationale. Am J Nurs. 2002;102(7):77-80.

Talen MR, Valeras AB. Integrated behavioral health in primary care: evaluating the evidence, identifying the essentials. Springer; 2013.

Primary Health Care Corporation. Primary Care Walk in Service Triage Policy. 2023. Available from: https://healthstandards.org/files/Primary-Care-Walk-in-Service-Policy.pdf. Accessed on 8 February 2025.

Siniscalchi KA, Broome ME, Fish J, Ventimiglia J, Thompson J, Roy P, et al. Depression screening and measurement-based care in primary care. J Prim Care Community Health. 2020;11:2150132720931261.

Pawson R. The Science of Evaluation: A Realist Manifesto. 2013.

Ouellet S, Galliani MC, Gelinas C, Fontaine G, Archambault P, Mercier E, et al. Strategies to improve the quality of nurse triage in emergency departments: a realist review protocol. Nurs Open. 2023;10(5):2770-9.

Olakotan OO, Mohd Yusof M. The appropriateness of clinical decision support systems alerts in supporting clinical workflows: a systematic review. Health Inform J. 2021;27(2):146045822110075.

Albagmi S. The effectiveness of EMR implementation regarding reducing documentation errors and waiting time for patients in outpatient clinics: a systematic review. F1000Research. 2021;10:514.

Mills PD, Weeks WB. Characteristics of successful quality improvement teams: lessons from five collaborative projects in the VHA. Joint Commiss J Qual Saf. 2004;30(3):152-62.

Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med. 2018;18(1):58.

Mental Health of Children and Young People in England, 2017 (PAS). 2018. Available from: https://digital.nhs.uk/data-and-information/ publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017#. Accessed on 8 February 2025.

Zenebe Y, Akele B, W/Selassie M, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatr. 2021;20(1):55.

Hu T, Zhao X, Wu M, Li Z, Luo L, Yang C, et al. Prevalence of depression in older adults: a systematic review and meta-analysis. Psychiatr Res. 2022;311:114511.