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Abstract
Background Chronic illness impacts mental health, reinforcing the need for screenings. Intensive pediatric mental health resources are scarce with prolonged wait times. Primary care providers are intermediaries for these screenings but patients with chronic illness have more frequent specialty visits. Previously known barriers to screening in specialty practices have been lack of time, resources, and knowledge.
Objectives This project’s aim is to better address mental health through increased anxiety screening in a pediatric nephrology clinic and provide intervention to reduce anxiety.
Methods The General Anxiety Disorder assessment was performed on patients ≥12 years with race, gender and ethnicity distribution shown in figure 1. Using quality improvement methodology, a multidisciplinary team developed and tested a toolkit, resource guide and stepped protocol. Patients with scores ≥5 received intervention and were rescreened in 3 months.
Results Over 24 months,1093 screenings were performed on 663 unique patients with 47% scoring ≥ 5. From those scoring ≥ 5, 77% received intervention demonstrating process reliability (figures 2 and 3). Staff concerns were addressed using a stepped protocol (figure 4) allowing patients identified with higher anxiety to be managed easily in clinic flow. Needing intervention were 248 patients who scored above 10 (moderate anxiety), but only 16 required emergency protocol activation (score ≥ 20). In addition, 66% of intervened patients with initial screening scores ≥5 reported decreased or unchanged anxiety at rescreening (figure 5).
Stepped protocol to address staff concerns
Re-screening results
Conclusions Attenuating anxiety is critically important. Higher levels of mental health care are associated with increased costs and have minimal availability. Results indicated most rescreened patients demonstrated unchanged or improved anxiety levels after intervention. The greatest improvement was seen in patients with the highest levels of anxiety. This successful implementation of mental health screening and its change package can be utilized in any clinical setting, incorporating it into pre-visit planning to insure sustainability.