NURS FPX 4905 Assessment 2 Define and Analyze Your Healthcare Process Problem or Issue of Concern

Student Name

Capella University

NURS-FPX-4905

Professor Name

Submission Date

A Practicum Analysis: Healthcare Process Issue

The problem of antidepressant drug failure has become one of the critical issues in adult care that can be observed at the Mayo Clinic and impacts the overall effectiveness of depression treatment. It is known that antidepressants have proven to be an effective first-line treatment option in major depressive disorder, with the vast majority of patients undergoing such medications failing to stick with them (Unni et al., 2024). This poor adherence results in non-responsive treatment and decreased overall improvement in symptoms.

Antidepressants non-adherence leads to the exacerbation of depressive symptoms, increased risk for relapse and recurrence of depression, avoidable hospitalizations, and increasing healthcare costs. In this paper, the researcher seeks to answer the healthcare process question pertaining to the non-adherence of antidepressants medications, the variables behind patient behaviors regarding antidepressant adherence, and the use of nurse-led education and follow-up intervention.

Description of the Practicum Site

My practicum hours are being completed at a practice site at Mayo Clinic in the United States (US), a community-based ambulatory health care facility that provides services in psychiatric evaluation of adults and provision of psychotropic medications to adults with psychiatric disorders, particularly dementia patients. The study reported that clinics have a great impact on increasing accessibility and assist in long term maintenance treatment by routine monitoring of chronic psychiatric disorders and individual treatment (Gibbons, 2025). The practice of the clinic is regular outpatient care by making regular follow-ups, as opposed to acute care/emergent care. The patient population tends to be 25 and above in age, tends to be diagnosed with major depressive disorder (MDD), and tends to be prescribed an antidepressant to help manage the MDD, given frequent follow-ups for MDD as routine follow-ups.

The majority of the patients require complete nursing care, rehabilitation, medications, activities of daily living, and behavioral issues as a result of dementia. At a follow-up, the MDD examines medication, depressive symptoms, Medication compliance and any adverse effects, effectiveness of current treatment, and provides therapeutic support where necessary. The facility has roughly 350 full-time healthcare workers: psychiatrists, psychiatric nurse practitioners, registered nurses, medical assistants, behavioral health counselors, as well as administrative support. Such providers apply an interdisciplinary approach to foster best, client-centered, evidence-based behavioral health care to support depression management and treatment continuity among patients on an antidepressant prescription.

Clinical and Operational Decisions at the Practicum Site

The operational and clinical choices at my practicum site to enhance antidepressant medication adherence. The process of identifying non-compliant patients; education tailored specifically to the barriers each patient experienced; scheduling follow-up with high-risk patients with a nurse once a week and recording the medication adherence evaluations and nursing interventions into the electronic health records; and discussing concerns with my preceptor and the interdisciplinary team to amend the treatment plan when needed were all part of the clinical decisions. Research has shown that effective care coordination and follow-ups lead to opportunities for reduced patient risk and improved flow of care in outpatient behavioral health services (Leila, 2026).

These activities were mentored and directed by my preceptor as a nursing student, with me screening patients on adherence, educating patients individually on their particular barriers to medication adherence, and documenting their assessment in the electronic health record (EHR) as a follow-up. The psychiatric prescriber made the decisions to prescribe; however, my clinical assessment and documentation helped in assisting clinical decision-making.

The previous literature confirmed that more follow-up visits, both nurse-led and interdisciplinary collaboration, improved patient medication adherence, quality of care, fewer hospitalizations, and resulted in better patient outcomes, which is linked to better management and suppression of depression symptoms, relapse prevention, and an improved quality of life (Shani, 2024). The severity of depression is measured using the Patient Health Questionnaire-9 (PHQ-9), and adherence to medication was a very important quality indicator in this group of patients. These clinical choices and outcome indicators were consistent with safe and evidence-based care that would perhaps enhance depression management in the long term in this facility.

Antidepressant Non-Adherence and Patient Outcomes

The healthcare process issue I have assessed at the Practicum site has been non-adherence to the use of antidepressant medication with adult depressed outpatient clients. Many adults prescribed selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as a group are frequently unable to adhere to the therapy-taking instructions, negatively impacting the effectiveness of the therapy, severity of symptoms, and risks of relapse or hospitalization. A Nurse-led Quality improvement intervention would be responsive to the problem. The interventions include screening medication adherence conducted by a registered nurse (RN), individual patient education, weekly phone calls, visits with an RN, entering all the data into the EHR, and interdisciplinary team collaboration.

Existing Evidence: Not all individuals adhere to antidepressant medication, which has been singled out as a common healthcare problem. In one study, Unni et al. (2024) found that the non-adherence rate in the US was 42.9% and in a five-country population in Europe, 46.2%. Their research concluded that the causes of non-adherence that were more frequently mentioned were forgetfulness and concerns about medications. On the same note, another study conducted by Chanie et al. (2025) revealed that the non-adherence rate of a depression treatment group (adults) was 32.9%, and the main factors that influenced the non-adherence rate were based on the fact that they were women, lacked literacy, were unemployed, the duration of treatment, and experienced severe adverse reactions to the medication. Gutirrez-Abejn et al. (2023) also concluded that inadequate medication adherence correlates with an increase in healthcare costs, rate of relapse, visits to the emergency room, and hospitalizations. These results justify the application of an interdisciplinary approach, including a Nurse-led intervention in order to enhance medication adherence.

Analysis of Impact on Quality, Safety, and Cost

The effects of antidepressant medication non-adherence are harmful to both the health care recipient and the health care system. Poor medication adherence leads to failure in treatment, slower recovery and remission rates, and eventually, reduced quality of care and patient outcomes. Research showed poor antidepressant adherence significantly decreases the effectiveness of treatment, as well as contributes to sustained depressive symptoms (Infante-Ventura et al., 2025).

In addition, safety-wise, medication non-adherence poses additional risks of relapse, antidepressant withdrawal syndrome, ED visits, and hospitalizations. It was also found that there are poor adherence to antidepressants leads to poor clinical outcomes (Chanie et al., 2025) and a high cost burden, as studies have estimated that non-adherent antidepressant usage in itself accounted for more than 13% of annual antidepressant costs and was not therapeutically beneficial (Gutirrez-Abejn et al., 2023). Nurse-initiated screening to identify medication adherence, individualizing patient education, and providing structured follow-up care should be considered to maximize medication adherence, patient safety, reduce health care costs, and guarantee patient well-being in the long-term among adults receiving treatment to manage depression.

Causes and Root Cause of the Problem

There were a number of explanations as to why antidepressant medication was not adhered to in adults with depression. Factors included missed doses, withdrawal of treatment because of adverse effects of medications, and lack of showing an improvement in the symptoms in a timely fashion. Researchers cited forgetfulness of taking medication and concerns about the medication as the most common causes of non-adherence (Unni et al., 2024). Non-adherence risk was related to low health literacy, unemployment, and side effects. Moreover, a complicated regimen and the presence of multiple prescribers also affect adherence. Also, the inadequacy of follow-up care, the lack of continuity of care, and medication cost also influenced adherence. It may be tackled by way of an extensive review with emphasis on non-compliance, nurse-directed evaluation, specific patient training, and regularly scheduled follow-up.

Practicum Hours

My 10 practicum hours were completed at Mayo Clinic, and this time was supervised by my preceptor. During the initial hour, I completed clinic orientation and reviewed the workflow and population of the clinic, including the point of the project. During the second hour, I could track some follow-up visits with psychiatry patients and learn about screening for medication adherence and depression symptoms with the PHQ-9 (Patient Health Questionnaire-9). During the third hour, I assisted in identifying some patients who did not take their medications that were prescribed as antidepressants and talked about common obstacles to medication adherence.

During the fourth hour, I had an opportunity to conduct one-on-one education with patients on medication adherence and how to cope with medication side effects. During the fifth hour, I had an opportunity to shadow medication management appointments and to be informed about the interdisciplinary collaboration in care as applied to patient management. At hour six, I practiced recording medication adherence screenings and interventions by the nurse in the EHR. During hour seven, I helped with patient identification of those patients who needed a nurse-led follow-up visit on a weekly basis.

During the eighth hour, I continued to educate patients on the importance of taking medication and scheduling. During the ninth hour, I went through the scores of patients’ PHQ-9 and discussed their response and progression to treatment with my preceptor. In the tenth hour, I reflected on my time in the practicum and how nurse-led education, coordinated follow-up, and interdisciplinary care might impact the success of medication adherence, safety of patients, and the overall treatment outcomes for the adults presenting with major depressive disorder.

Conclusion

Compliance with antidepressants still remains a challenge in effective depression management within the Mayo Clinic environment. The practicum experience has solidified the fact that the patient, treatment, and system factors influence adherence. The most effective evidence-based interventions to reduce the barriers are nurse-led interventions of adherence screening, customized patient education, and systematic follow-up, which have the best evidence available. The evidence-based approach(s), as it has been discovered during this experience, applied to the management of major depressive disorder may help bring about better adherence to medication, better safety, quality, and efficient utilization of resources, eventually leading to improved outcomes.

References

Chanie, G. S., Belachew, E. A., Limenh, L. W., Beyna, A. T., Mengesha, A. K., Bayleyegn, Z. W., Melese, M., Azanaw, J., Sendekie, A. K., & Simegn, W. (2025). Prevalence and determinants of antidepressant non-adherence among patients with major depressive disorder in Ethiopia: A multi-center cross-sectional study. Scientific reports, 15(1). https://doi.org/10.1038/s41598-025-15102-9

Gibbons, M. B. C., Tyler, J., Crits-Christoph, P., Cristancho, M., Galbraith, J., Chiu, R. Y., Duong, L. A., & Oquendo, M. A. (2025). A multifaceted outpatient treatment model for mood and anxiety disorders designed to optimize both treatment outcomes and access to care. Psychotherapy, 62(3). https://doi.org/10.1037/pst0000576

Gutiérrez-Abejón, E., Pedrosa-Naudín, M. A., Fernández-Lázaro, D., & Alvarez, F. J. (2023). Medication economic burden of antidepressant non-adherence. Frontiers in pharmacology, 14. https://doi.org/10.3389/fphar.2023.1266034

Infante-Ventura, D., Rodríguez-Díaz, B., Bello, M. Á. G., Valcárcel-Nazco, C., Estupiñán-Romero, F., Artiles, F. J. A., de León, B. G., Navarro, I. H., & del Pino-Sedeño, T. (2025). Analysis of therapeutic adherence to antidepressants and associated factors in patients with depressive disorder: A population-based cohort study. Journal of affective disorders, 23(2), 119443. https://doi.org/10.1016/j.jad.2025.119443

Leila, A. R. (2026). Improving referral and continuity of care through structured outpatient disposition planning enabled by electronic referrals: A quality improvement study. Cureus, 25(1). https://doi.org/10.7759/cureus.100727

Shani, M., Lustman, A., Comaneshter, D., & Schonmann, Y. (2024). Overall medication adherence as an indicator for Health outcomes among elderly patients with hypertension and diabetes. The American journal of medicine, 137(8), 736–741. https://doi.org/10.1016/j.amjmed.2024.04.020

Unni, E. J., Gupta, S., & Sternbach, N. (2024). Reasons for non-adherence with antidepressants using the medication adherence reasons scale in five European countries and united states. Journal of affective disorders, 344(3), 446–450. https://doi.org/10.1016/j.jad.2023.10.010