this is the PICOT question: In the home health setting of patients age range between 60-75 years old with depression symptoms does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptoms changes for clinical depression by 100% of patients over a period of 6 months?

PICOT Question:
P: In the home health setting of patients age range 60-75 with depression symptoms.

I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.

C: Using GDS-15 screening tool VS PHQ-2 SCREEN

O: to improve identification of the clinical depression in the elderly by 100%.

T: in the initial office visit and over a 6 month period?

The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal.

On or before Day 7, of week eight each student will submit his or her final proposal paper to the week eight assignment link in D2L. This formal paper will include and expand upon work completed thus far in prior assignments.

Essential Components of the Final Project Proposal will include:

Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
Overview of the Problem – Discuss the problem, why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing.
Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project.
Literature Review – Provide the key terms used to guide a search for evidence and discuss at least five (5) summaries of relevant, credible, recent, evidence-based research studies to support the project proposal.
Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies.
Develop an EBP Standard – Describe two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered.
Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.
Expectations

Format: Formal scholarly paper in APA 7th ed format
Reference Citations: A minimum of five, recent (past five years), peer-reviewed scholarly references cited in APA 7th ed format.

ANSWER

Home Health Setting Depression Screen PICOT

Introduction

Symptom-based psychiatric rating scales were introduced to the healthcare system more than three decades ago to enable the health practitioners to give values to the complex array of actions, distresses, and emotional state of the patient. The screening tools have proliferated into an array of scales that are created for a range of goals. Utilization of validates gauges in diagnosis, screening, as well as evaluating reaction to treatment in clinical depression is vital while offering proper care.

The evidence-based practice aims to comparing the performance and effectiveness of PHQ-2 and GDS-15 as screening tools in the early identification of symptoms, severity, and monitoring of symptom changes for clinical depression. The practice guidelines for depression screening are evidence-based. Therefore, this research will focus on evidence based practice to support the most effective depression screening tool for early identification and monitoring symptom changes for clinical depression. Due to the large estimates of undertreated and underdiagnosed depression in home healthcare settings, improved screening has been considered efficient in reducing the burden of depression. Notably, screening can facilitate the improvement of clinical depression diagnosis among adults. The evidence-based intervention project plan aims at examining how the identification of clinical depression can be improved by 100% through either PHQ-2 or GDS-15 as screening tools within the home healthcare settings to lower the risk of clinical depression among the elderly depending on their accuracy and performance.

Overview of the Problem

The performance and diagnostic quality of a screening tools vary in terms of accuracy expressed as specificity and sensitivity of depression screening. Considerably, major depression has been present among the medically ill elderly but is rarely diagnosed or treated since the conditions are rarely identified. Therefore, this has been linked to greater mortality and morbidity, high medical costs, and increased use of health services (Cahoon, 2012). This form of depression has existed on a continuum of severity from low, mild, severe to long term symptoms that have had a major influence on the individual’s quality of life. Depression among the elderly is difficult to acknowledge due to different presentations among the elderly. Therefore, most elderly people have to undergo varying assessments to examine what kind of treatment is necessary for the form of depression. The recent interventions in screening depression that have been integrated by the mental health services have raised the number of patients that are treated for depression as well as the treatment quality. Considerably, many research studies indicate that the recognition and monitoring of depression among the elderly has become a burden due to lack of reliable and accurate ways to confirm the depression.

Structured psychotherapy and antidepressant have been combined for treatment, follow-up, and relapse maintenance for older adults with depression (Diniz and Reynolds, 2014). However, depression screening tools have become barriers to the optimal treatment and identification of clinical depression due to variation in performance and accuracy in screening depression. For instance, home healthcare workers have failed to recognize depression among the elderly in their clinical judgment. Amassing evidence within home healthcare settings suggests the need for improved intervention levels which include the most effective depression screening to facilitate collaborative treatment and improve the outcomes of the depressed patient.

Project Purpose Statement

The purpose of the evidence-based practice intervention project is to improve the identification and monitoring of clinical depression among the elderly by 100%. Considerably, patients expect to receive the best care which is based on the most available evidence. The purpose of the evidence-based intervention on depression screening was to add knowledge and awareness on the best depression screening in home healthcare settings for early identification of symptoms and monitoring symptom change for clinical depression. Therefore, this will improve an understanding on the most relevant screening tool in monitoring and identification of symptoms.

Background and Significance

Depression has become a common problem globally. Most elderly people are affected by depression disorders. Depression has been highly prevalent among medically ill elderly individuals who have indicated major depression. However, despite the increased prevalence of depression among the homecare settings, studies have suggested that only a small percent of the elderly are receiving adequate treatment despite the fact that evidence-based screening and treatment options for different forms of depression exist (Cahoon, 2012). Due to its long term effects, it can increase the risk of death among the elderly.

Over the years, it has been realized that depression among the elderly has been linked to under treatment and lack of diagnosis. Most treatments by the primary care providers have been poorly managed. Depression has greatly contributed to the global burden of a disease reflecting both the great consequences and prevalence across the age span. Problems related to depression in later life have increased risk of medical illness, personal suffering, caregiver burden, social isolation, and mortality (Diniz and Reynolds, 2014).

Despite the fact that there exists intervention within the homecare settings, the number of adults showing severe depressive signs and symptoms has exceeded within the homecare settings. The high numbers have of elderly people depressed within the homecare settings have a meaningful effect on the overall burden of depression among the elderly.

Depression screening and monitoring have been used for depression treatment. Various assessment tools have been used to help detect depression among older adults. Tools such as the Geriatric Depression Scale, Zung Self rating depression scale, and Hamilton rating scale have been used to screen elderly people for depression within the healthcare setting. Depression screening entails the use of screening tools to identify symptoms and monitor a patient who might have depression so that they can be assessed further and appropriate treatment offered (Tsoi et al., 2017). The identification of depression during primary care has been an urgent concern nationally and locally.

Considerably, integrated depression screening tools are considered as the initial step of depression care since the screening can be utilized as an internal referral for the home care worker in the depression treatment of the patient at home. Depression screening lowers the barriers of depression care and offers the patient direct access to the required treatment services (Tantchou, Coulter and Hudson, 2014). The opportunity for early identification and monitoring symptoms will lower the cost of external mental health therapists as well as maximize depression care. Therefore, there is a need to improve recognition and depression treatment among the elderly within home healthcare settings.

Utilization of routine diagnostic screening can improve the recognition of depression among the elderly with significant function and physical impairment. Clinical depression may be present more among the elderly with the patients not showing any depressed moods as the major complaint. However, the patient may complain of feeling unwell in no specific way or may even complain of physical symptoms such as indigestion, abdominal pain, and constipation. Most of the depression patients have overlooked the underlying depression due to the overemphasis on the physical complaints. For instance, these symptoms have been overlooked among older patients with physical and cognitive limitations. Therefore, depression screening is essential among elderly patients to facilitate early interventions and monitoring of the symptoms.

The evidence-based research will indicate the most effective screening tool for elderly adults within homecare settings. Systematically evaluating depressive symptoms through screening scores may gauge the depression severity and act as a guide for the client about effective treatment and interventions. The screening also establishes the baseline of the signs and symptoms that can be used to examine the effectiveness of the treatment.

PICOT formatted Clinical Project Questions

P: In the home health setting of patients aged range 60-75 with depression symptoms.
I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.
C: Using GDS-15 screening tool VS PHQ-2 SCREEN
O: to improve identification of the clinical depression in the elderly by 100%.
T: in the initial office visit and over a 6 month period?

Literature Review

Early identification – Early identification has been considered effective in the early treatment of clinical depression among the elderly. Clinical depression has been a severe depressive disorder with a sense of despair, profound sadness, and low mood. Many research studies that focus on treatment and identification of depressive disorders among the elderly focus on clinical depression due to its prevalence among old adults. Early identification of major depression has been focused on many research studies since early detection has been considered effective for appropriate treatment. Increasing evidence has indicated that intervening and preventing early for the elderly with mental issues can improve patient depression outcomes. Therefore, early identification of clinical depression has generated interest among researchers thus it will be important in this evidence-based research to support thinking related to major depression among the elderly.

Depression Screening – Depression screening is the main focus of evidence-based research. Depression screening entails to the utilization of screening tools to detect patients with depression but have failed to be recognized. There are various tools that have been used for screening depression and identify possible clinical depression. Depression screening is an essential part of depression therapy and appropriate care. Depression screening is an essential search keyword since it will match the research problem thus offering relevant information for evidence-based research.

GDS-15 – Clinical depression among the elderly has been prevalent due to the growing population of old adults. Major depression has been associated with increased morbidity, mortality rates, and increased use of health services making major depression an important public health issue. The 15-item GDS version is an interview-based scale that has been widely accepted due to its validity, reliability, and accuracy (Marc, Raue, and Bruce, 2008). GDS-15 is the most universally recommended assessment for older adults with depression. This is an interview-based form with 15 questions that are used to assess the behavioral and affective symptoms without the somatic complaints which prevent other scales from being valid for adults. GDS-15 item is a suitable screening test for major depression symptoms among the elderly. It is an ideal test for evaluating clinical severity and for monitoring the symptoms and treatment for depression. The 15 items are selected due to their high correlation with depressive signs and symptoms. High scores reveal high depressive symptoms preset while a score of 6 or more indicates the presence of depression which indicates further assessment needed. Considerably, GDS-15 has effective properties as a screening tool for major depression among the elderly.

PHQ-2 – This is an effective self-administered instrument for screening depression which inquires about the extent to which a person has experienced depressive mood over the past two weeks. The tool incorporates DSM-IV depression criteria and other leading key depressive symptoms that are combined into a brief report that is utilized for screening, identification, choosing, and monitoring treatment options (Levis, Benedetti, and Thombs, 2019). The purpose of PHQ-2 is not to offer the final treatment or diagnosis but to screen for depression severity.

For the purpose of this paper, the relevant and credible evidence-based research studies that will support the project proposal include:

Tantchou, L., Coulter, L., & Hudson, J. (2014). What is the most effective method for screening for depression in a nursing facility setting?. Evidence-Based Practice, 17(11), 13.

This study has examined different screening tools to determine the most effective method for screening for depression within a nursing facility. The screening tools compared include GDS-15, DRS, and PHQ-2 which may help with screening for depression within the nursing care facility. Among the methods of screening, PHQ-2 has been considered the most effective and practice due to its ease of use.

Tsoi, K. K., Chan, J. Y., Hirai, H. W., & Wong, S. Y. (2017). Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 255-260.

The study has compared the diagnostic performance of GDS-15 and PHQ-2 as screening instruments among older adults. The study is a meta-analysis and systematic review that aims at evaluating the diagnostic accuracy of PHQ-2 and GDS-15 while evaluating the specificity and sensitivity of the primary outcomes.

Cahoon, C. G. (2012). Depression in older adults. AJN The American Journal of Nursing, 112(11), 22-30.

The study has focused on determining the specificity and sensitivity of three depression scales to identify and diagnose major depression among the elderly. The number of participants was 129 who were involved in a semi-structured psychiatric interview to examine the diagnosis of major depression. The study has offered evidence in support of the utilization of GDS-15 and PHQ-9 which are easy to administer and simple to interpret while diagnosing major depression among older adults.

Marc, L. G., Raue, P. J., & Bruce, M. L. (2008). Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population. The American Journal of Geriatric Psychiatry, 16(11), 914-921.

The study aimed at assessing the reliability and validity of GDS-15 among the elderly in a diverse elderly home care population. The study has indicated that screening of depression with GDS-15 is effective among the elderly since it is brief, simple, and time-effective. Major depression was identified and diagnosed using GDS-15 suggesting the accuracy of the scale in diverse populations.

Manea, L., Gilbody, S., Hewitt, C., North, A., Plummer, F., Richardson, R., … & McMillan, D. (2016). Identifying depression with the PHQ-2: A diagnostic meta-analysis. Journal of Affective Disorders, 203, 382-395.

This study has focused on the use of PHQ-2 which is a very brief instrument to identify depression. The study is a systematic review that was carried out to evaluate the studies that had examined the diagnostic performance of PHQ-2 as a major depression detecting tool.

Critical Appraisal of Literature

Critical appraisal of the literature is considered as the process of evaluating reliability, validity, and applicability as it links to the PICOT question. Supporting evidence from multiple evidence-based research articles has supported screening for major depression among older adults. Evidence from the results indicates that screening for depression should rely on highly specific screening tools such as GDS-15 and PHQ-2 rather than using clinical judgment to determine depressive symptoms among the elderly. GDS-15 has been considered reliable and valid tools for screening the elderly for major depression in homecare health settings. According to (Tsoi et al.,2017) the psychometric performance of both GDS-15 along with the relative brevity and ease of use has made more reliable and attractive in screening for depression among older adults. The supporting evidence from the literature has indicated that GDS-15 is essential in detecting major depression as well as monitoring the symptom changes.

Develop an EBP Standard

Evidence-based practice involves the integration of the most effective research evidence with patient values and clinical expertise. The EBP will involve the formulation of the question in order to recognize a problem and assess the need for change. The PICOT question in this case will be utilized to formulate a researchable clinical question with an evidence-based practice framework. The next step will be to gather evidence from both external and internal evidence. The external evidence will be gathered from scientific literature will the internal evidence will be gathered from patients through a randomized control trial to determine the effectiveness of the intervention. The third step will be to critically analyze the gathered evidence. Ideally, analysis of the evidence will be conducted to determine the reliability and validity of GDS-15 and PHQ-2 in facilitating early identification of clinical depression as well as managing symptoms among the elderly.  The fourth step is to develop the intervention plan which entails designing the most effective screening tool for the homecare settings to help in identifying clinical depression and managing symptoms among the elderly. The fifth step is to implement and assess the intervention plan. This will include evaluating the outcomes of the project and analyze how the process of identifying depression among the elderly in the homecare settings has improved. The last step is to integrate and maintain the intervention through shared recommendations among stakeholders to integrate the intervention plan into the homecare settings standard of practice.

Implications

EBP is an intervention with strong scientific proof that offers positive outcomes for varying disease disorders. EBP for the elderly with depression are essential since they can improve function and health as well as lower symptoms of major depression. The Evidence-based intervention plan will be completed in a homecare setting through a randomized selection of subjects to evaluate the effectiveness in improved identification of major depression among the elderly.

Expectations

The outcome of the project is expected to offer intervention for depression screening among the elderly within home healthcare settings. The current method is utilized for the identification of major depression among the patients is clinical judgment. Therefore, the project aims to establish which of the two, PHQ-9 and GDS-15 is accurate and reliable identifying depression among the elderly. A potential randomized trial will offer meaningful evidence about the feasibility and effectiveness of PHQ-9 and GDS-15 screening tools in identifying clinical depression and managing symptoms among the elderly. Therefore, the research-based evidence is expected to offer improved interventions for routine screening protocol to assist in early identification of symptom severity and monitor symptoms changes for clinical depression.

References

Cahoon, C. G. (2012). Depression in older adults. AJN The American Journal of Nursing, 112(11), 22-30.

Diniz, B. S., & Reynolds, C. F. (2014). Major depressive disorder in older adults: benefits and hazards of prolonged treatment. Drugs & aging, 31(9), 661-669.

Manea, L., Gilbody, S., Hewitt, C., North, A., Plummer, F., Richardson, R., … & McMillan, D. (2016). Identifying depression with the PHQ-2: A diagnostic meta-analysis. Journal of Affective Disorders, 203, 382-395.

Marc, L. G., Raue, P. J., & Bruce, M. L. (2008). Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population. The American Journal of Geriatric Psychiatry, 16(11), 914-921.

Tantchou, L., Coulter, L., & Hudson, J. (2014). What is the most effective method for screening for depression in a nursing facility setting?. Evidence-Based Practice, 17(11), 13.

Tsoi, K. K., Chan, J. Y., Hirai, H. W., & Wong, S. Y. (2017). Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 255-260.