Bites

November 2009

Research

Collaborative care

The role of practice nurses

Volume 38, No.11, November 2009 Pages 925-926

Mark A J Morgan

James Dunbar

Prasuna Reddy

Background

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.

Methods

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 detect depression.

Results

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.

Discussion

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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Correspondence afp@racgp.org.au

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