As a Graduate Nursing student completing clinicals in a Primary Care Clinic in Flint, Michigan in Genesee county, you notice that depression screening is not being consistently conducted by providers for the adults seen in the clinic.
When screening is conducted, providers are asking questions but not using an evidence-based tool which provides a depression score. Referrals are occasionally made for positive answers to provider questions. Providers have indicated they do not have the time and are not confident in diagnosing and treating depression. You would like to propose that providers screen for depression using the USPSTF depression screening guideline (2023). (Review page 16 in Melnyk & Fineout.)
You have been asked to propose changes to provider practice. Providers in this clinic include physicians, NPs and PAs. MAs take the patients to the clinic room and conduct a basic assessment (VS, weight). When requested, both the MAs and the clerical staff assist with having patients take self-administered tests.
Using the USPSTF depression screening guideline (2023) and the Burning Clinical Problem you developed for your provider presentation, write the PICOT questions addressing providers and patients.
| Provider PICOT | 35 points |
| Provider Population
List all providers and personnel in the Primary Care Clinic who will receive the educational intervention you will provide including physicians, NPs, PAs, MAs, clerical staff.
Resource: Clinical scenario above.
Answer – write the (P) of the PICOT here:
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| Intervention –
In the provider PICOT question, the intervention is the educational intervention/presentationfor providers. If applicable, the provider intervention also includes screening tool(s), intervals for screening, and referrals.
Educational presentation– Describe the educational intervention you will provide. How will you conduct the presentation? Will the presentation utilize PPTs? Will it be conducted in-person, virtual, or completion of computer module? Describe the content of the intervention. What follow-up will be offered? Reminders?
If applicable, review the screening tool(s) recommended by the selected guideline and referral recommendation(s) for a positive screen. This information should be included in the education program.
Screening tools/Screening Intervals/Referrals– What is the guideline recommendation for this population with this diagnosis for screening and referrals? What are the recommended screening intervals? When should the intervention (referrals) be implemented?
Resources: Screening Tools – review the USPSTF depression screening guideline(2023) for information on the screening recommended by this guideline. See “Screening Tests” within Practice Considerations for screening recommendations. For additional information on screening, review the JAMA article on the evidence summary (which is also linked in the guideline). On page 2069, the authors indicate that any version of the Patient Health Questionnaire (PHQ) may be used. On page 2072 of this article, the authors describe the sensitivity and accuracy of the PHQ-2 and PHQ-9. For this assignment, use PHQ-2 and PHQ-9. Review the APA overview of the PHQ-2 and PHQ-9 tools. Describe when each will be used.
Resources: Screening Intervals – See “Screening Intervals” within Practice Considerations.
Resources: Referrals – See “Implementation” within Practice Considerations for referral recommendations for a positive screen.
Answer – describe the (I) of the PICOT here:
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| Comparison
What is the current practice of the providers in the Primary Care Clinic in Flint, Michigan regarding this issue.
Resource: Clinical scenario above.
Answer – write the (C) of the PICOT here:
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| Outcome
What is the behavioral change you expect to see in providers after the educational intervention? Outcomes must be specific, measurable, relevant to the population. The outcome must be measurable by a statistical test (such as Chi-Square test). For example, include the number of patients treated/screened/referred before and after the intervention.
Answer – write the (O) of the PICOT here:
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| Time
What is the length of time which will be necessary to collect data after the educational intervention is completed? (For purposes of students’ QI projects, 3-months is the time allotted for T.) Answer – write the (T) of the PICOT here:
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| Provider PICOT Question | 15 points |
| Provider PICOT question – write the entire provider PICOT in one narrative sentence containing all the PICOT elements with each element identified in ( ) – (P), (I), (C), (O), (T).In your answer, remember to write the PICOT question with provider as the population, an educational session as the intervention, and outcomes measured by chart review.
Answer
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| Patient PICOT | 35 points |
| Population
Describe all relevant demographic information necessary to identify the patient population including gender, age range, reading ability, cognitive ability. Include co-morbidities in the population for the study. What are your exclusion criteria?
Resources: Review the USPSTF depression screening guideline (2023) for information on the population to which this guideline is directed. See “Patient Population Under Consideration” and “Assessment of Risk” within Practice Considerations for Inclusion and Exclusion criteria.
Answer
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| Intervention –
In the patient PICOT question, the intervention is the education. If applicable, the patientintervention also includes screening tool(s) and referrals patients may receive.
Describe any information you plan to provide for patients such as brochures or one-on-one teaching. If applicable, list the screening tools and/or referrals for positive screens.
Answer
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| Comparison
What is the current treatment plan/screening used for this population with this diagnosis in this practice?
Resource: Clinical scenario above.
Answer
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| Outcome
What are the changes in patient behavior expected after this intervention The outcomes must be measurable by a statistical test. What is the patient’s behavioral or physiological response such as acceptance of screening or referral?
Answer
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| Time
What is the duration of time which will be required to collect outcome data for patients who receive the intervention? (Standard for DNP projects – minimum of three months.) Answer
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| Patient Research Question | 15 points |
| Patient PICOT question – write the entire patient PICOT in one narrative sentence containing all the PICOT elements with each element identified in ( ) – (P), (I), (C), (O), (T).
In your answer, remember to write the PICOT question with the patient as the population and the interventions to be implemented with patients. (For example, educational information such as brochures, screening, referral for positive screen.) Outcomes must be measured by chart review.
Answer
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