DNP Evidenced-Based Capstone Project

Implementation of Routine Anxiety Screening in a Rural Health Clinic: An Evidence-Based Project 

Anxiety disorders are the most common mental health diagnosis in the United States. Despite the commonality, anxiety disorders are often undiagnosed and undertreated. Underdiagnosis and undertreatment of anxiety are particularly pronounced in rural areas. In fact, 60% of rural America is in a mental health provider shortage area. The consequences of failing to diagnose and manage anxiety can result in impaired occupational functioning, diminished quality of life, exacerbation of physical health issues, strain on interpersonal relationships, and suicide. Although it is recommended that all adults be screened for anxiety, no recommendation exists on the timing or frequency of the screening.

  • How does implementing a routine GAD-2 screening tool with an anxiety treatment toolkit at a rural primary care clinic influence the healthcare team’s perception of the quality of care in adults ages 18-64 compared to current practices? 

  • The aim of this project was to address the problem of underdiagnosed and undertreated anxiety in a rural clinic by implementing routine screening to impact early detection and timely intervention and a resource toolkit to affect accessibility and clinician confidence in caring for people with anxiety.

  • This evidence-based project included the development and implementation of utilizing the GAD-2 during as a routine screening tool at Langdon Prairie Health. Information and education regarding use of the GAD-2 was provided to staff at the rural primary care clinic during a staff meeting. Pre-surveys were distributed to assess staff confidence regarding anxiety and the GAD-2 tool. The effectiveness of the GAD-2 tool was evaluated using post-implementation surveys.

  • Results of the project were based on a total of 5 post implementation surveys (n=5) completed by staff at Langdon Prairie Health. Out of the total staff members surveyed, 100% (n=5) strongly agreed with feeling confident administering the GAD-2 tool. Only 80% (n=4) of those surveyed strongly agree with feeling confident in identifying anxiety. Of those surveyed, 100% (n=5) would recommend the GAD-2 tool for screening anxiety in the selected population and were satisfied with the implementation of the GAD-2 project.

  • Overall, the findings suggest that the use of the GAD-2 is of beneficial use to Langdon Prairie Health. This project has many limitations such as the limited number of surveys filled out and limited times the GAD-2 was utilized. The project leaders recommend that future efforts by the clinic should focus on utilization of the GAD-2 for all routine visits for adults ages 18-63.