Improving the Diagnosis and Management of Generalized Anxiety Disorder Through the Implementation of the GAD-7

Introduction: Anxiety disorders affect millions of American adults in any given year, causing feelings of fearfulness and uncertainty. Individuals suffering from anxiety often have difficulty controlling personal feelings, which may negatively affect relationships and daily activities. Anxiety can be divided into a variety of different disorders, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia. In the clinic setting, diagnosing any type of anxiety disorder can be challenging and can present differently in every person. Often times, screening for anxiety symptoms and measuring the severity of symptoms are difficult due to the lack of utilizing evidence-based anxiety assessment tools to aid in patient care. The aim of the performance improvement project was to increase accuracy in diagnosing and monitoring treatment effectiveness through implementation of the GAD-7 anxiety tool in the assessment of patients with GAD-type symptoms that present in a primary care setting, as well as to evaluate the effectiveness of the intervention.

Methodology: The performance improvement project was the review and formative evaluation of the effectiveness in implementing the GAD-7 anxiety assessment tool in the diagnosis and management of patients with GAD. The project incorporated disease prevalence, nursing and change theories, evidence-based guidelines, and pre-project assessment of the provider use of and knowledge regarding the value of using anxiety assessment tools in the assessment, diagnosis, and ongoing evaluation of patients with GAD, compared to post-project assessment of the same areas at a primary care clinic between December 2015 and March 2016.

Conclusion: As a result of the performance improvement project, the providers at the primary care clinic utilized the GAD-7 anxiety assessment tool in the diagnosis and management of GAD patients 100% of the time. However, the providers noted prior to implementation that documentation of DSM-V criteria met for diagnostic relevance to GAD was stronger pre-project implementation as opposed to post-project implementation. The providers realized the main focus was on tool usage in general, as opposed to utilization of the GAD-7 tool to support diagnostic reasoning pertaining to DSM-V criteria for GAD diagnosis. The providers also verbalized increased satisfaction in their ability to accurately diagnose and monitor treatment effectiveness with regards to GAD due to utilization of the GAD-7 tool. The primary care clinic is continuing the project indefinitely, in an effort to continue providing high quality, evidence-based care to the patients served.