The Connection Between Practice Problems, Evidence, and Interventions Essay

The Connection Between Practice Problems, Evidence, and Interventions Essay

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How the evidenced-based intervention will solve the practice problem

The evidence-based intervention I selected is using the PHQ-9 tool to diagnose major depressive disorder. The delivery of most mental health care occurs in primary care settings, where depression is the most presenting psychiatric symptom. Due to the high prevalence of MDD globally and the consequences of untreated MDD, the capability of primary care providers to effectively make a diagnosis and provide treatment is of critical importance.  However, more than half of patients in primary care settings with MDD remain untreated. According to Samples et al. (2020)The Connection Between Practice Problems, Evidence, and Interventions Essay, the low rate of depression treatment can partly be attributed to low rates of identification.   Less than fifty percent of primary care patients with depression are appropriately identified by general practitioners. Nevertheless, patients who fail to meet diagnostic criteria for MDD are at times misdiagnosed with MDD and treated, which reflects barriers to the appropriate diagnosis.

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Diagnostic ambiguity is a major issue major issues in depression diagnosis. Depression diagnosis requires the patient to present at least two of the major symptoms, and a minimum of four other symptoms out of nine total criteria, with the symptoms, persisting for at least two weeks.  The PHQ-9 tool is an evidence-based depression screener designed to decrease diagnostic uncertainty (Samples et al., 2020). The PHQ-9 is a self-report of the PRIME-MD (Primary Care Evaluation of Mental Disorders), developed by Pfizer Inc in the mid-1990s. Patrick and Connick (2019)  the PHQ-9 depression screening tool evaluate depressive symptoms over the previous  2 weeks, with nine items each following four response options for the frequency at which an individual experiences symptoms. A total score is obtained by summing up the scores and the total score is interpreted against pre-set thresholds. The standard cut-off score for screening to detect possible MDD is ten or above. Patients with positive screening results are then evaluated to establish if they have MDD and, if suitable, provided treatment.

A patient can independently complete the PHQ-9 and then the clinician reviews and clarifies positive answers. Initial trials demonstrated that it takes two minutes for a patient to complete the PHQ-9 while clinicians take less than two minutes to review the patient’s responses.  To facilitate the utilization of the PHQ-9, clinicians can first screen patients utilizing the PHQ-2, which is limited to two items(anhedonia and depressed mood)The Connection Between Practice Problems, Evidence, and Interventions Essay. If the results are positive, or if the health care provider suspects depression despite a negative screen, he/she is required to utilize the full PHQ-9.  PHQ-9 has high internal validity, that is, individuals can complete the test many times and obtain consistent scores every time. This enables clinicians to utilize the PHQ_9 in tracking changes in mood over time.  In addition, the PHQ-9 is clinically valuable because it identifies degrees of depression severity (severe, moderately severe, moderate, and mild) rather than dichotomously categorizing depression.

If the PHQ-9 is in the public domain or if authorization is required to use the evaluation tool

The tool is publicly available and no authorization is needed to use the tool. Also, PHQ-9 can be incorporated into electronic health records. . Sinclair-McBride et al. (2018). Posit that the PHQ-9 is a psychometrically sound and freely available measure recommended by the United States Preventative Services Task Force for utilization in depression screening in primary care and other settings. O’Byrne and Jacob (2018) emphasize that the PHQ-9 is free, simple, and short, which facilitates its utilization in clinical practice. The PHQ-9 is usually a recommended screening tool in primary care as well as research involving primary care populations.  Provided that health care providers are critical of the PHQ-9, there are no ethical issues when the tool is utilized appropriately in clinical practices The Connection Between Practice Problems, Evidence, and Interventions Essay.

References

O’Byrne, P., & Jacob, J. D.  (2018). screening for depression: Review of the Patient Health Questionnaire-9 for nurse practitioners.  Journal of the American Association of Nurse Practitioners, 30(7), 1. DOI:10.1097/JXX.0000000000000052

Patrick, S., & Connick, P. (2019). Psychometric properties of the PHQ-9 depression scale in people with multiple sclerosis: A systematic review. PLoS One, 14(2), e0197943. doi: 10.1371/journal.pone.0197943

Sinclair-McBride, K., Morelli, N., & Gusman, M. (PHQ-9 Administration in Outpatient Adolescent Psychiatric services.  Psychiatric Services, 69(7), 837-838. doi: 10.1176/appi.ps.201800145

 Samples, H., Stuart, E. A., Saloner, B., Barry, C. L., & Mojtabai, R. (2020). The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits. Journal of General Internal Medicine, 35 (1), 12-20. doi: 10.1007/s11606-019-05192-3 The Connection Between Practice Problems, Evidence, and Interventions Essay

Discussion
Purpose
The purpose of this assignment is to examine an evidence-based intervention that will serve as the possible solution for improved outcomes at your practicum site.

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Instructions
Reflect on your readings this week and provide your proposed DNP practice change project evidence-based intervention. Respond to the following:
1. Examine how the evidence-based intervention you have identified will resolve the practice problem at your specific practicum site.
2. Identify your evidence-based intervention and explain if it is in the public domain or if authorization is required to use the intervention.
3. Identify if the evaluation tool (PHQ 9) you plan to use for your DNP practice change project is in the public domain or if authorization is required to use the evaluation tool.

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