1 / 56

Epidemiology

DEPRESSION CARE: USING THE chronic CARE MODEL IN A UNIVERSITY HEALTH CENTER By Roxanne Wolfram, DnP , RN, FNP-BC ACHA Annual Meeting, Thursday, June 3, 2010 rwolfram@iusb.edu. Epidemiology. Worldwide 5%-10% of population 121 million affected ½ depressed adults get treatment WHO, 2009.

carmelitah
Download Presentation

Epidemiology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DEPRESSION CARE: USING THE chronic CAREMODEL IN A UNIVERSITY HEALTH CENTERByRoxanne Wolfram, DnP, RN, FNP-BCACHA Annual Meeting, Thursday, June 3, 2010rwolfram@iusb.edu

  2. Epidemiology Worldwide • 5%-10% of population • 121 million affected • ½ depressed adults get treatment WHO, 2009

  3. Epidemiology Nationally Life-time prevalence 15.3% - 16.9% University Student • Higher prevalence 8.7% - 43.4% Andrade et al., 2003; CDC, n.d.; Kessler, 2003; Ohayon, 2007; ACHA, 2009; Steptoe, Tsuda, Tanaka, & Wardle, 2007; Wardle et al., 2004; Vasquez & Blanco, 2008; Wong, Cheung, Chan, Ma & Tang, 2006; Stecker, 2004; Dahlin, Joneborg & Runeson, 2005, WHO, 2009

  4. Epidemiology ACHA NCHA II • 22.7% felt very sad in the past 12 months • 20% felt hopeless in the past 12 months • 13.7% felt so depressed it was difficult to function

  5. Epidemiology ACHA NCHA II • 11.1% of students felt depression affected their academic performance • 9.2% of students were diagnosed or treated by a professional for depression • 3.8% seriously considered suicide • 0.8% attempted suicide

  6. Complications of Depression • Suicide • Reduced quality of life • Reduced social functioning • Role impairment • Excess disability WHO, 2009; CDC, n.d.; Kessler, 2003; Kessler & Walters, 2003

  7. Complications of Depression • Occurs with anxiety • More likely to have CVD, DM, asthma, and obesity • More likely to smoke, be physically inactive, and drink alcohol Andrade et al., 2003; CDC, n.d., Kessler, 2003; Ohayon, 2007

  8. Diagnosis and Treatment Insufficient • 30% properly diagnosed and treated Chizobam et al., 2009; WHO, 2009; Wittchen, 2009

  9. Recommendations • USPSTF (2002) recommends screening for depression in clinical practices that have systems in place that assure accurate diagnosis, effective treatment, and adequate follow-up

  10. Recommendations • Healthy Campus 2010 goal: “improve mental health and ensure access to appropriate, quality mental health services” ACHA, 2002 p. 66

  11. Definition of Depression Unipolar depression: • Major depressive disorder (MDD) • Dysthymic disorder • Depressive disorder not otherwise specified (NOS) APA, 1994

  12. Major Depressive Disorder • Depressed mood • Diminished interest (anhedonia) APA, 1994

  13. Major Depressive Disorder • Significant weight loss or gain or decreased or increase in appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or excessive or inappropriate guilt • Diminished ability to think or concentrate or indecisiveness • Recurrent thoughts of death, recurrent suicidal ideation without a specified plan or a suicide attempt, or a specific plan for committing suicide

  14. Dysthymic Disorder • A depressive disorder that is characterized by at least two years of depressed mood for more days than not • Accompanied by two of the following: • Poor appetite or overeating • Insomnia or hypersomnia • Low energy or fatigue • Low self-esteem • Poor concentration or difficulty making decisions • Feelings of hopelessness

  15. Depressive Disorder NOS • Included for diagnostic coding of depression that has features that do not meet criteria for the other depressive disorder

  16. Significance of the Problem • Improve depression care • Sample of 50 students • 18% were diagnosed with depression • 24% had a history of depression

  17. Purpose/Question • What are the effects of using the Chronic Care Model (CCM) on depression outcomes with a group of students compared with a group using current practice at a Midwestern university health and wellness center?

  18. Purpose/Questions • Outcomes measured • Detection of depression • Depression improvement • Patient compliance with medication • Patient satisfaction

  19. Review of Literature • Databases Searched • Cochrane • Academic Search Premier • CINAHL • Health Source: Nursing/Academic • MEDLINE • PsycArticles • ERIC

  20. Review of the Literature • Key Terms Used • Depression and multifaceted interventions • Depression and collaborative care • Depression and chronic care model • Depression and disease management

  21. Review of the Literature • Inclusion Criteria • January 1, 1999 to January, 31 2010 • English • Age 18 to 64 • More than one intervention • Primary care

  22. Review of the Literature • Exclusion Criteria • Patients with pre- or postnatal depression • Care specific to one gender

  23. Review of the Literature Abstracts identified using search terms N = 939 Excluded N = 901 Articles met criteria for review N = 38 Articles met criteria for review from hand searches N = 63 Excluded N = 87 Articles met inclusion criteria N = 14 Articles valid and reliable N = 9

  24. Review of the Literature

  25. Review of the Literature • Sample sizes: 10 – 55 articles • Patients described as depressed • 5-18 multifaceted interventions used

  26. Review of the Literature Models that guided the literature search and interventions: • Chronic Care Model (3 reviews) • Collaborative Care (3 reviews) • Disease Management Program (2 reviews) • 1 looked at multifaceted interventions

  27. Review of the Literature Interventions: • Delivery system design: • Case management • Regular follow-up • Culturally appropriate care • Defining each provider’s roles and tasks ICSI, 2009; Wagner et al., 1999

  28. Review of the Literature 2. Self-Management Support: • Educating patients about their disease • Providing emotional support • Helping set priorities and goal setting • Developing strategies for living with chronic illness ICSI, 2009; Wagner et al., 1999

  29. Review of the Literature 3. Clinical Information Systems • Electronic health records • Paper registry systems ICSI, 2009; Wagner et al., 1999

  30. Review of the Literature 4. Decision Support • Provider education to stay up to date • Evidence based guidelines in daily practice • Sharing of evidence based guidelines and information with patients to encourage their participation ICSI, 2009; Wagner et al., 1999

  31. Review of the Literature 5. Community Resources • Encouraging patients to participate in effective community programs • Forming partnerships with community organizations to support patient interventions • Advocating for policies to improve patient care ICSI, 2009; Wagner et al., 1999

  32. Review of the Literature 6. Health System • Leadership that visibly supports improvements at all levels • Leadership that provides incentives based on quality of care • Leadership that encourages open and systematic handling of quality problems to improve care ICSI, 2009; Wagner et al., 1999

  33. Review of Literature Outcomes from implementing multifaceted interventions caused improvement in: • Depression (all 9 articles) • Medication adherence (6 out of 6 articles) • Patient satisfaction (2 out of 2 articles) • Depression detection through screening (1 out of 1 article)

  34. Review of the Literature • Less likely to cause depression improvement: Provider education and feedback • More likely to cause depression improvement: Case management and patient preference

  35. Decision to Change Practice • Systematic reviews • Provider preference • CCM • PHQ-9 depression screening tool • Institute for Clinical Systems Improvement (ICSI; 2009) practice guideline

  36. RN Discuss the Project with Patient Usual Care Declines AlgorithmforDepressionCare Yes Randomly draw envelope Usual Care Unexposed Exposed Usual Care 2 simple questions No Yes PHQ-9 screening tool Usual Care Score 0-4

  37. Algorithm for Depression Care PHQ-9 screening tool Depressed No: Reevaluate Interview Assess comorbidites Treat Assess response Good: Continuation or Maintenance Phase

  38. Implementation or Methods • Ace Star Model • Quasi experimental design • Convenience sample • University students • Age 18 and older • Midwestern university health and wellness center • Randomly assigned • Consented

  39. Implementation or Methods Interventions based on the CCM: • Delivery system • Patient self-management • Clinical information system • Decision support • Community resources • Health care system

  40. Data Analysis/Evaluation Sample Size • 91 (65%) agreed to participate and 49 (35%) declined • Eight patients withdrew (8.8%) • Total of 83 patients, 47 (57%) exposed, 36 (43%) unexposed

  41. Data Analysis/Evaluation Sample Characteristics for Entire Group • 22 males (26.5%) and 61 females (73.5%) • Age range between 19-53 years, mean age 27 • 15 patients diagnosed with depression (18%)

  42. Data Analysis/Evaluation Demographic Data for Entire Patient Population in Study

  43. Data Analysis/Evaluation Demographic Data for Depressed Population

  44. Data Analysis/Evaluation Demographic Information for Depressed Patients (n = 10)

  45. Data Analysis/Evaluation (n = 10)

  46. Data Analysis/Evaluation • 10% declined medication/counseling • 70% used antidepressant medication • 90% used on-campus counseling • 30% referred to psychiatrist

  47. Outcome 1: Depression Detection • 21.3% detected in the exposed • 13.9% detected in the unexposed • X²(df) = .751(1) • p = .386 • No statistically significant difference

  48. Data Analysis/Evaluation Outcome 2: Changes in PHQ-9 Scores

  49. Data Analysis/Evaluation Outcome 3 and 4:

  50. Data Analysis/Evaluation • Patient Satisfaction with the Care Received • Of the questionnaires sent out • 4 (11%) completed with 2 (50%) in the exposed and 2 (50%) in the unexposed group • 5 (14%) returned with no forwarding address • 6 (16%) completed without a name

More Related