Enhancing depression knowledge and treatment adherence through patient education : a quality improvement project
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Background Depression affects 280 million people globally and is the leading cause of disability worldwide, with non-adherence rates of 30%–60% within three months of treatment. Many psychiatric settings lack structured patient education programs, a critical gap in rural outpatient settings. This QI project implemented and evaluated a standardized education intervention to enhance depression knowledge, improve medication adherence, and reduce symptom severity. Objectives: (1) a 5% increase in depression knowledge; (2) a 5% increase in medication adherence measured by the MARS; and (3) a reduction in PHQ-9 and GAD-7 scores from pre- to postintervention. Methods • A literature review identified three themes: barriers to treatment adherence, effective methods to reduce barriers, and interventions to increase outcomes. Structured psychoeducation and collaborative care consistently improved knowledge, reduced stigma, and increased adherence. • A one-group pre-post PDSA design was used at a rural outpatient psychiatric clinic. A tenminute standardized education session was delivered in-person or via telehealth; brochures were distributed via patient portal. Forty adults with PHQ-9 ≥10 or ICD-10 MDD diagnosis were enrolled. • The PHQ-9, GAD-7, MARS, and Depression Knowledge Survey (KNO) assessed outcomes. Wilcoxon signed-rank tests with Vargha-Delaney A analyzed ordinal data; paired samples ttests with Cohen’s d analyzed total scores; p ≤ .05. Results • Depression knowledge increased 22.2% (M = 65.2% to 79.8%, p < .001, d = 3.4); medication adherence increased 15.9% (M = 5.5 to 6.4, p < .001, d = 1.1); depression severity decreased 9.7% (M = 16.0 to 14.5, p < .001, d = 1.3); and anxiety severity decreased 8.4% (M = 14.9 to 13.6, p < .001, d = 1.7). PHQ-9 and GAD-7 severity distributions shifted toward lower categories post-intervention. No statistically significant difference between female (n = 35, 87.5%) and male (n = 5, 12.5%) in pre-intervention MARS scores (U = 50.00, Z = −1.589, p = .133), post-intervention MARS scores (U = 42.50, Z = −1.892, p = .065), or score change (U = 52.50, Z = −1.526, p = .157). Conclusions • Findings support integrating brief, standardized patient education into routine psychiatric intake and quarterly follow-up workflows. Annual content updates and extension to patients with comorbid anxiety are recommended. Future projects should evaluate long-term knowledge retention and sustained adherence beyond three months. IRB Approval IRB approval through exempt review. Co-Authors DR. Nancy M. Birtley, Dr. Shelby Thomas, Dr. Kofi Baffour Gyamfi Learning Objective: The purpose of this QI project was for the learner to be able to describe how a structured patient education intervention improves depression knowledge and treatment adherence in adults with positive depression screening in an outpatient psychiatric setting.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License.