To develop a system of care for patients with co-morbid depression, coronary heart disease (CHD) and/or diabetes.
Six general practices from the Greater Green Triangle region (Hamilton, Camperdown, Colac, Warracknabeal in Victoria, Mt Gambier and Bordertown in South Australia) participated in the study, which involved (i) practice staff attending two depression management training programs (March and November 2006) and (ii) practice nurses screening for depression in type 2 diabetes and CHD patients using two assessment tools; Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ9). Screening results were incorporated into General Practice Management Plans (GPMPs), where degree of depression determined management technique; internal counselling by practice nurses, Better Outcomes in Mental Health (BOMH) or referral to mental health services. Patient data (283 GPMPs) were collected from September 2006 - January 2007, while training evaluation data were collected before and after each workshop.
Preliminary data from the pilot phase of the study will be presented, evaluating the usefulness of training programs and outlining the characteristics of the patients screened. Future data using organisational assessment tools will evaluate the effectiveness of this chronic disease model of care.
The findings from this study will help to identify the strengths and weaknesses of this model, in an attempt to demonstrate its feasibility, and furthermore generalisability to other primary care settings in both rural and urban contexts.
This model has implications on service delivery in general practice by (i) benefiting patients through identifying and managing co-morbid depression, diabetes and CHD, (ii) distributing chronic disease case management thus easing the workload of general practitioners, (iii) developing the capacity of practice nurses in order to internally manage mild cases of depression where previously undetected and (iv) incorporating chronic disease management into business plans, sustained under Medicare Benefits Scheme (MBS) chronic disease management item numbers.
Managing chronic disease
O'Neil A, Dunbar J, Reddy P, Bunker S. (2007). Chronic disease management of co-morbid depression, heart disease and diabetes in primary care. In: 2007 General Practice and Primary Health Care Research Conference: Program & Abstracts. Primary Health Care Research and Information Service, Australia. phcris.org.au/conference/abstract/3554