Flinders & Deakin Universities In the presence of a chronic - - PowerPoint PPT Presentation
James Dunbar & Prasuna Reddy Greater Green Triangle University Department of Rural Health Flinders & Deakin Universities In the presence of a chronic disease, depression is under diagnosed and under treated despite clear evidence
In the presence of a chronic disease,
WHO states that two thirds of this depression
There is a real need to address co-morbid
International studies
have Major Depressive
have Coronary Heart disease8
Chronic Heart disease have major depression, 20% have minor depression9
8 Jurado et al, ‘Prevalence of cardiovascular disease and risk factors in a type 2 diabetic population
9 Blumenthal JA, ‘Depression and coronary heart disease: association and implications for treatment’, Cleveland Clinic Journal of Medicine, vol 75 suppl 2, pg S48-53, 2008
Data from 10 general practices in Victoria Patients with depression (PHQ-9 >5) more likely to
raised anxiety levels, poor social connectedness, smoke, low levels of physical activity
Most had not been identified or treated for
Roughly half of all patients were not in range for
Majority of patients did not know target ranges
Medical Research Council: A Framework for development and evaluation of RCTs for complex interventions to improve health: April 2000
Continuum of increasing evidence IMPACT Collab Care Rural GGT practices Rural & Metro Practices SA VIC NSW
Based on the IMPACT method
from University of Washington, Seattle, USA
Recognises depression as a
complicating factor in chronic disease management
Patients are screened for
depression using PHQ-9
Licence from IMPACT to
Australianise the model
Nurse as Case manager
coordinates visits to dieticians, psychologists, podiatrists and
Medical Research Council: A Framework for development and evaluation of RCTs for complex interventions to improve health: April 2000
Continuum of increasing evidence IMPACT Collab Care Rural GGT practices Rural & Metro Practices SA VIC NSW
Relation between context, problem definition, intervention, and evaluation for complex interventions
GPs and Practice Nurses enlisted from 6 rural
Training program, electronic data searching and
Patients with diabetes or heart disease identified
Of 322 participants, 34% had high PHQ-9 scores. Follow up after 3 to 6 months, depending on risk
At recall, some depression scores had improved. Some clinics did not recall patients because they
Medical Research Council: A Framework for development and evaluation of RCTs for complex interventions to improve health: April 2000
Continuum of increasing evidence IMPACT Collab Care Rural GGT practices Rural & Metro Practices SA VIC NSW
TrueBlue project research question:
Recruits patients on registers with diabetes or heart
Among the first studies of depression management
Quantitative and qualitative data on process of care,
Northern Rivers Melbourne West and South Adelaide
Nurse-led collaborative-care approach
Funded at the clinic level using Medicare item
45-minute appointments with practice nurses. Patients complete lifestyle questionnaire and
Usual physiological parameters measured by
Patients develop up to three personal goals in
Appointment made with GP to complete GP
Practices recall patients every three months over a
Patient goals are updated based on what happened
There is a high acceptance of the
Practice income from Medicare is
30 patients identified as at risk of suicide.
5 10 10 15 15 20 20 25 25 30 30 35 35 40 40 45 45 50 50 >50% Improved Not Improved <50% Improved
Great ater er Green en Triangl angle Univ iver ersit sity Depart rtmen ment t of Rural al Healt lth Flinde inders and Deakin kin Univer ersitie sities