Primary Care Implementation of an Evidence-Based Protocol Addressing Women’s Behavioral Health: An Interrupted Time Series Analysis

BACKGROUND: 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. OBJECTIVE: 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). DESIGN: 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. PARTICIPANTS: Women aged 18-44 within 20 Ohio primary care practices participating in FOM. INTERVENTIONS: 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. MAIN OUTCOME MEASURE(S): 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. KEY RESULTS: 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). CONCLUSIONS: FOM implementation was associated with improvements in screening and treatment of anxiety and depression across a statewide network and warrants broader scaling investigation.