Identifying depression before it impacts health
Identifying depression before it impacts health
Company hopes screening will boost outcomes
LifeMasters, a disease management provider based in Newport Beach, CA, recently added a depression screening tool to its disease management protocol for diabetes and cardiovascular disease. With the National Institutes of Mental Health in Bethesda, MD, estimating that depression is as high as 30%, or three times the national average, in adults with chronic illness, and that 50% of all individuals with depression are undiagnosed, LifeMasters’ philosophy is that identifying and treating depression will improve patient outcomes and save health care dollars.
"Depression is significantly more prevalent among those with chronic illness," says Jeffrey M. Davis, MD, LifeMasters chief medical officer and developer of the company’s depression screening tool. "Without diagnosis and treatment, depression often gets in the way of individuals’ desire to effectively manage their health. Our tool gives them a way to remove this barrier."
Disease management programs promote self-care in individuals with chronic illness, but depression often causes lack of motivation, which hinders necessary behavior change and self-care activities, he notes. "Our interventions enhance self-care for individuals with chronic disease. More than 90% of the outcomes we achieve depend upon individuals and whether or not they comply with taking care of themselves and following medical directions," says Davis. "We get a much bigger bang in terms of disease control if individuals understand their own disease and follow instructions for managing it. It requires behavior change, lifestyle change. If you take that and juxtapose it with depression, it’s clear that individuals who are depressed are not motivated to change. Depressed patients will tell you that."
The tool is a nine-question quick screen administered over the telephone by LifeMasters nurses. "The screen is based on the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders] depression criteria checklist. If a patient answers yes’ to five or more of the nine questions, the nurse notifies the patient’s primary care provider and recommends that a further diagnostic assessment be conducted," says Davis.
LifeMasters nurses contact patients at high to moderate risk for disease complications weekly during their first month of enrollment in a disease management program. Patients are assigned a primary care nurse and receive a packet that includes a photograph and a brief biography of the nurse to help facilitate a more personal connection between the patient and the nurse. At the end of the first month of nurse mediated intervention, nurses administer the depression screen.
"We want to give the nurse time to develop a relationship of trust with the patient. There are things that patients are reluctant to share. We’re hoping that after four telephone calls, the patient will be comfortable enough with the nurse to answer the screening questions honestly," Davis says. "The nurse explains that a mental health assessment is part of the reporting LifeMasters provides to physicians. The nurse does not tell the patient that we are specifically screening for depression."
LifeMasters recently received permission from two of its clients to incorporate the depression tool into its disease management protocol for diabetes and cardiovascular disease. "Both plans are excited. Most qualified medical groups understand the role of depression in chronic disease, but physicians often don’t have the time necessary to address the issue with patients," Davis says.
"We will be tracking how many screenings are positive and how physicians manage positive screens. We’re trying to give physicians data to better manage their patients, but whether outcomes improve for these patients depends on how their physicians use the information," he explains.
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