Literature Collection

Depression is a common mental illness. Primary care providers are uniquely positioned to screen and manage patients with depression. A clinical pathway protocol may ensure timely screening, diagnosis, and treatment of depression. This evidence-based quality improvement project used an integrated team approach to implement a depression clinical pathway protocol (DCPP) at a multisite faith-based federally qualified health center. Results showed an improvement in one clinical quality measure, screening, and follow-up for depression, whereas center providers reported the protocol saved time and was easy to use. Using a DCPP may bridge the gap in depression screening and follow-up care.

We conducted a quality improvement (QI) study to increase rates of firearm screening/safety counseling by 25% over 10 months for children (4-18 years) at preventive visits in an academic continuity clinic. Plan-Do-Study-Act (PDSA) cycles consisted of 1) (January 2023) educating providers about best practices for screening, safe storage counseling, and use of cable firearm locks; 2) (May 2023) revising the preventive visit note template to prompt providers on best practices; and 3) (September 2023) providing caregiver educational resources to support safe storage practices. The baseline firearm screening rate was 38%. After PDSA 1, screening rates were 34%; following PDSA 2, screening rates increased to 82.5%; after PDSA 3, rates were 95%. This QI intervention increased provider screening for firearms, confidence in safety counseling, and confidence in the use of cable firearm locks during preventive visits. Revising the note template had the largest effect on increasing screening rates.

OBJECTIVE: To determine whether a pharmacistled intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting. DESIGN: Prospective quality improvement intervention in an academic family medicine clinic. METHODS: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set. RESULTS: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person. CONCLUSION: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.