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. 2008 Jun;5(2):111-9.

Depression Case Management by Practice Nurses in Primary Care: An Audit

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Free PMC article

Depression Case Management by Practice Nurses in Primary Care: An Audit

David Ekers et al. Ment Health Fam Med. .
Free PMC article

Abstract

Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches.Method An audit of symptom outcome and satisfaction was conducted in depression case-management clinics run by practice nurses. Results were then benchmarked against appropriate randomised trial data. The cost of practice nurse time devoted to the delivery of the service was estimated by multiplying time by unit cost.Results A mean change of 9.07 (standard deviation (SD) 6.67, 95% confidence interval (CI) 7.93-10.22, P < 0.001) points on the Patient Health Questionnaire (PHQ9) score was observed in those who were using/had used the service. Clinical change demonstrated a shift from moderate-to-severe to mild depression. The results reflect the changes seen in randomised controlled trial data from similar interventions in similar samples, and are superior to expected treatment as usual outcomes. Overall, respondents were 'very satisfied' with the service on offer. The mean cost of practice nurse time was estimated at £45 per patient.Discussion While acknowledging the limitations of audit data, practice nurses in general practice appear to be able to offer effective and acceptable case management to patients experiencing depression.

Figures

Figure 1
Figure 1
Patient status at time of audit. Number in italics outline baseline PHQ9 score, age and proportion of females in each group
Figure 2
Figure 2
Scatterplot of PHQ9 score pre-post intervention. Horizontal and vertical reference lines indicate mean of non-clinical sample plus one standard deviation. Diagonal reference line shows no change. Diagonal tram lines show minimal clinically important difference (MCID)

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