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Primary Care Implementation of an Evidence-Based Protocol Addressing Women’s Behavioral Health: An Interrupted Time Series Analysis
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DOI：10.1007/s11606-026-10657-3.png)
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Abstract
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Compared to other adults, US women of reproductive age are more likely to experience anxiety and depression; primary care interventions are needed to address barriers to evidence-based screening and treatment. To examine rates of evidence-based screening and management of anxiety and depression in primary care associated with implementation of a women’s behavioral health quality improvement learning collaborative, Focus on ME (FOM). An interrupted time series analysis assessed changes from baseline and changes in trends related to anxiety and depression screening and treatment after a positive screen before (January 1, 2021–February 28, 2022) and during (March 1, 2022–February 28, 2023) implementation. Women aged 18–44 within 20 Ohio primary care practices participating in FOM. FOM implemented a primary care behavioral health screening and management protocol developed with clinical experts and aligned with clinical guidelines, using a learning collaborative aligned with the Institute for Healthcare Improvement’s Breakthrough Series model. Primary outcomes: (1) change in practice-level Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) screening and (2) percentage of patients who received protocol-aligned treatment (PAT) after a GAD-7 score ≥ 10 or PHQ-9 score ≥ 15. FOM practices delivered 19,126 visits to women aged 18–44 across pre-implementation (13,247) and implementation (11,911), averaging 2245 visits/month. A total of 9448/19,126 (49.4%) of visits were with Medicaid beneficiaries. Compared to pre-implementation, the 12-month FOM implementation period showed immediate and sustained increases in GAD-7 (change from baseline = 23.1% p < 0.05) and PHQ-9 (change from baseline = 18.1%, p < 0.001) screening, as well as PAT for anxiety (change from baseline = 25.9%, p < 0.05) and depression (change from baseline = 38.0%, p < 0.001). FOM implementation was associated with improvements in screening and treatment of anxiety and depression across a statewide network and warrants broader scaling investigation.
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