P3B239: Store It Safe: A QI Program with Primary Care Providers to Improve Depression and Suicide Screening and Restricting Lethal Means Access Counseling

Purpose/Objectives: Suicide is the 2nd leading cause of death in US adolescents, with 40% due to firearms. Primary care providers (PCPs) have an opportunity to screen teens for depression and suicidality, discuss crisis planning and address restricting lethal means access. Depression screening alone is not enough as 36% of youth screened positive for suicide but negative for depression. Data show that 80% of teens visited a healthcare provider within a year of completing suicide, emphasizing the need for screening in the primary care setting. The objective of our SIS program was to improve PCP screening for depression and suicide and counsel on lethal means access at adolescent well-child visits (WCV).

Design/Methods: Pediatric and family medicine (FM) practices were recruited by Ohio AAP staff and self-selected to participate. Practice teams, comprised of at least a lead physician and practice manager, learned QI basics and how to use depression and suicide screening tools and provide available resources at a half-day learning session. Providers worked to implement screenings into every adolescent WCV and provide appropriate action plans for at-risk patients between August 1, 2022 and February 28, 2023. Also, each provider was instructed to discuss lethal means access and offer free lockboxes at every WCV. Data was collected using an electronic tool and consisted of date of visit, patient gender identification, patient race and payor/insurance, whether they completed depression and suicide screens, guidance regarding suicide risk and safe storage of lethal means and any interventions that were recommended.

Results: 14 practices (7 pediatric/7 family medicine) consisting of 90 providers (20 pediatric/70 family medicine) participated. Compared to onset of the program, depression screening stayed constant at 62% in both pediatric and FM practices by the end of the collaborative. However, suicide screening increased significantly from 161 (13%) to 1,849 (57%) (23 (7%) to 1,203 (71%) pediatric vs 138 (18%) to 646 (43%) FM) and lethal means counseling increased from 327 (39%) to 1,511 (47%) (in particular, 14 (3%) to 450 (32%) FM). 325 (18%) of depression screens and 117 (7%) of suicide screens were positive during the collaborative. Providers addressed 712 (90%) of positive screens. Most common recommendations were: counseling (149), medication (144), and psychiatry referral (50). 125 (41.0%) of lockboxes provided were given to families. Most common reason for not accepting a box was already had one.

Conclusion/Discussion: Providing PCPs significantly improve suicide screening, lethal means counseling and offering resources when QI methodology is used in a primary care setting. Providing PCPs with screening tools, lockboxes and resources to a large group of PCPs could potentially reduce the US suicide rate.