Nurses at Bay Pines VA Healthcare System are working to bridge the gap between primary care and mental health services through the Depression Care Management Program.
Studies show that most patients with depression are detected in primary care settings and that about 20% of primary care patients screen positive for depressive symptoms. Primary care providers had expressed difficulty with managing the care of depressed patients within a primary care setting, citing obstacles such as an inability to follow recommended monitoring guidelines because they cannot address both medical and psychiatric issues within a brief appointment session. Implemented in 2007 and modeled after the Translating Initiatives for Depression into Effective Solutions system, an evidence-based collaborative approach to depression management, DCM was created to improve services for veterans suffering from depression by providing comprehensive care within a primary care setting.
Veterans are monitored and treated through an evidence-based, six-month telephone program managed by mental health RNs. RNs evaluate depression and suicidal behavior during telephone appointments, monitor medication compliance and side effects, and provide psycho-educational information. The DCM team also includes a part-time mental health clinical nurse specialist, a nurse manager, and a consulting psychiatrist.
In the past two years, 97 patients have completed the program, with 105 patients currently undergoing treatment. To encourage safety, the program uses a thorough assessment of each patient’s psychosocial status, including evaluation tools that assess suicide risk and identify protective factors and establish a safety plan. Upon completing the program, depressive symptoms are reduced by 70%.
As a result of the DCM program, there has been a significant reduction in PHQ-9 scores with correlated symptom relief from discharged patients. The PHQ-9 Depression Screening instrument is a 10-question, evidence-based tool used during each appointment for evaluating depressive symptoms.
In fiscal year 2008 the average initial PHQ-9 score was 10.8 with the average discharge score at 3.5, a significant reduction in depressive symptoms. During the first two quarters in fiscal year 2009 the average initial score was 11.6 with the discharge score at 3.4.
Bay Pines also has seen more direct referrals from primary care physicians instead of the mental health triage area, meaning shorter wait times for patients and improved access to mental health triage and other services. Patient satisfaction is evident in discharge comments from the veterans and feedback from other disciplines.
Studies show that most patients with depression are detected in primary care settings and that about 20% of primary care patients screen positive for depressive symptoms. Primary care providers had expressed difficulty with managing the care of depressed patients within a primary care setting, citing obstacles such as an inability to follow recommended monitoring guidelines because they cannot address both medical and psychiatric issues within a brief appointment session. Implemented in 2007 and modeled after the Translating Initiatives for Depression into Effective Solutions system, an evidence-based collaborative approach to depression management, DCM was created to improve services for veterans suffering from depression by providing comprehensive care within a primary care setting.
Veterans are monitored and treated through an evidence-based, six-month telephone program managed by mental health RNs. RNs evaluate depression and suicidal behavior during telephone appointments, monitor medication compliance and side effects, and provide psycho-educational information. The DCM team also includes a part-time mental health clinical nurse specialist, a nurse manager, and a consulting psychiatrist.
In the past two years, 97 patients have completed the program, with 105 patients currently undergoing treatment. To encourage safety, the program uses a thorough assessment of each patient’s psychosocial status, including evaluation tools that assess suicide risk and identify protective factors and establish a safety plan. Upon completing the program, depressive symptoms are reduced by 70%.
As a result of the DCM program, there has been a significant reduction in PHQ-9 scores with correlated symptom relief from discharged patients. The PHQ-9 Depression Screening instrument is a 10-question, evidence-based tool used during each appointment for evaluating depressive symptoms.
In fiscal year 2008 the average initial PHQ-9 score was 10.8 with the average discharge score at 3.5, a significant reduction in depressive symptoms. During the first two quarters in fiscal year 2009 the average initial score was 11.6 with the discharge score at 3.4.
Bay Pines also has seen more direct referrals from primary care physicians instead of the mental health triage area, meaning shorter wait times for patients and improved access to mental health triage and other services. Patient satisfaction is evident in discharge comments from the veterans and feedback from other disciplines.
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