Mark A J Morgan
Comorbid depression can occur with diabetes and heart disease.
This article reports on a feasibility study focusing on additional roles
for practice nurses in detecting and monitoring depression with
other chronic diseases.
A convenience sample of six practices in southeast Australia was
identified. Practice nurses received training via a workshop, which
included training in the use of the Patient Health Questionnaire, to
The 332 patients who participated in the project each received a
comprehensive health summary to assist with self management.
Depression was identified in 34% of patients in this convenience
sample. After 18 months implementation, practice nurses were
strongly in favour of continuing the model of care. General
practitioners gave highly favourable ratings for effectiveness and
willingness to continue this model of care.
Practice nurses can include depression monitoring alongside
systematic care of diabetes and heart disease. A randomised trial is
currently underway to compare the clinical outcomes of this model
with usual care.
In patients with either type 2 diabetes mellitus or coronary heart disease the presence of depression leads to increased morbidity and mortality.1,2 This comorbid depression is often missed in routine general practice.3 To address these problems we describe the implementation of collaborative care based on new roles for practice nurses (PNs), information technology solutions, and a shift of focus toward self care. A similar model of collaborative care has been shown overseas to be an effective way to improve the management of depression in primary care.4
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