Nurs Womens Health. 2024 Jun;28(3):205-212. doi: 10.1016/j.nwh.2023.11.008. Epub 2024 Mar 19.
To improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire-9 (PHQ-9).
This quality improvement project was conducted using a plan-do-study-act cycle implemented with a postintervention study design.
SETTING/LOCAL PROBLEM: A medium-size REI center in a mid-Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring.
Patients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible.
INTERVENTION/MEASUREMENTS: The PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan-do-study-act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored ≥10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics.
A total of 115 participants were included. A screening rate of 84.3% (n = 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of ≥5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified included costs, personal preferences, and access to services.
The PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.
通过在初始就诊时使用患者健康问卷-9（PHQ-9）对所有患者进行筛查，提高在生殖内分泌学和不孕不育（REI）中心开始生育治疗的患者的抑郁筛查率。
这项质量改进项目使用计划-执行-研究-行动循环，并结合干预后研究设计进行。
地点/问题所在：在美国大西洋中部一个大都市地区的一个中等规模的 REI 中心，在那里，开始接受生育治疗的患者的心理健康状况筛查并未进行。
在 2022 年 10 月至 2023 年 2 月期间，有生育治疗新患者咨询预约的 REI 医生为其初始就诊患者提供 PHQ-9。
干预/措施：在为寻求生育治疗的患者进行初始就诊时，由医生实施 PHQ-9 调查。使用计划-执行-研究-行动模型的三个周期来实施变更。对于得分在 5 到 9 分（轻度抑郁）的所有患者，都进行了关于咨询转诊的讨论。对于得分≥10 分（中重度抑郁）的所有患者，都会生成咨询和药物管理的转诊。通过描述性统计对数据进行分析。
共纳入 115 名参与者。对开始治疗的患者，筛查率达到 84.3%（n=97）。在 97 名接受筛查的患者中，有 21 名患者的得分≥5；19 名患者被转介进行咨询。然而，在 2 个月的随访期间，没有患者参加咨询会议或开始接受初级保健医生开的药物治疗。确定的障碍包括费用、个人偏好和服务获取。
PHQ-9 筛查工具在生殖内分泌学诊所实施，以提高心理健康筛查的频率，并提供必要的转诊。然而，需要进一步跟进，以确保患者接受适当的心理健康护理。
