Effective treatment of Depression
in General Practice
Goodfellow Unit 2015
Expanding the Primary Care Team
The Role of the Practice Nurse
William Ferguson
TREATMENT RESISTANT
DEPRESSION?
• 15% wrong diagnosis (substance abuse,
drug effects, thyroid dysfunction, brain
tumour)
• 40% Treatment compliance issues (Denial
of illness, fear of “addiction” delayed onset
of action , partial improvement in
symptoms, drug side effects )
Follow-Up and follow –through of depressed patients in Primary Care :
The critical missing components of quality care
Solberg L,Trangle M,Wineman A-JABFP 2005;18:520-7
• US study surveyed treatment compliance
and follow up in primary care after a
diagnosis of major depression
• 67% had stopped treatment by 3m
• Only 36% had at least one follow up visit
to GP by 3m
• 12% had 2 visits
• Barely 1% had 3 or more visits by 6m
We are part of the problem
GPs tend to take a single episode approach
to what is really a long term condition
“Improving outcomes for patients with major
depression is not as simple as prescribing
a new treatment – the whole process of
care needs to be enhanced ”
David Goldberg
• “In the gradual division of labour by which
civilization has emerged from barbarism,
the doctor and nurse have been evolved .”
William Osler 1891
Follow Up
See us frequently at first. A week is a long time
in a Dali landscape. Three weeks are almost
unimaginable. Give us a reliable number we
can call. This makes us feel that someone
sees us as valuable. Inexplicable from our
point of view, but nice.
K.McCall
“now that ladder’s gone,
I must lie down where all the ladders start
In the foul rag and bone shop of the heart”
William Yeats
Our model uses the nurses already in the
General Practice setting, and builds on
the existing bonds between Primary Care
Providers and patients.
“ The type of treatment matters less than
ensuring it is done properly and followed
up”
Edward Wagner
Effective treatment of Depression
in General Practice
Goodfellow Unit 2015
Expanding the Primary Care Team
The Role of the Practice Nurse
William Ferguson
Managing Depression as a chronic disease :A randomised trial of
ongoing treatment in primary care. Rost K, Nutting P, Smith J
BMJ 2002;325: 934-9
• 2 year follow up , case management by
nurse phone follow up
• Intervention group 33% more likely to be in
remission
• Intervention group had 24 % better mental
function ,17% better physical function than
the usual care group
Efficacy of Nurse Telehealth Care
• Usual care vs Usual Care plus Nurse THC
• N=302, F/U at 6 weeks , 6 months
• At 6weeks > 50 % improvement achieved
by 37 % in usual care group ,50 % in TLC
group
• At 6months >50 % improvement achieved
by 38 % usual care,57% in TLC group.
Hunkler et al Arch Fam Med Vol 9 Aug
2000
• The difference between nurse telehealth
care and usual care is as large as the
difference between drug and placebo in
the treatment of depression.
• Drug vs Placebo=+18%
• Usual vs Telehealth=+19%