Depression. VNAA Best Practice for Home Health

Transcription

1 Depression VNAA Best Practice for Home Health

2 Learning objectives The participant will be able to: Discuss two reasons why depression should be identified and treated Discuss two critical interventions for patients with depression Discuss two tools used to screen for depression and the appropriate age for the screening

3 Why depression? It is estimated that depression is a diagnosis that affects between 14-46% of the homebound elderly. (Bruce, 2002) It is a factor in increased medical and functional disabilities and increased risk of falls and hospitalization. (Byers et al., 2008; Sheeran, Byers, & Bruce, 2010) Depression is a prevalent co-morbidity with heart disease, cancer and diabetes. (Kang-Yi and Gellis, 2012) Depression is often under-recognized and even when recognized, under-treated. (Bruce, 2002) Estimates of the direct and indirect medical costs of patients with depression were approximately 83.1 billion in the year (USPSTF, 2009)

4 Best Practice Definition All patients over the age of 18 will be assessed for depression as part of the admission process; the physician ordered plan of care includes interventions for depression for those patients who are identified as having a score of 6 or greater on the PHQ-9 or GDS.

5 Critical interventions/actions All patients will be screened using the PHQ-2 scale (OASIS question M1730) A score of 3 or more indicates the need for additional screenings Follow up screening should be done with the PHQ-9 for patients 64 and under and the Geriatric Depression Scale (GDS) for patients 65 and older to determine depression severity Notify PCP of both initial and follow up screening scores Care planning should include a request for MSW referral for community resources, mental health follow up based on available resources, obtaining order for appropriate medications and medication monitoring For those patients receiving mental health follow up treatment, agency may utilize secondary screening at discharge to determine if depression has been reduced

6 PHQ-2

7 PHQ-9

8 GDS

9 Other Tools: Hamilton Scale

10 Other Tools: Mini-Cog Test 3-minute instrument to screen for cognitive impairment in older adults Uses a three-item recall test for memory and a simply scored clockdrawing test (CDT) Effective as or better than established screening tests in both an epidemiologic survey in a mainstream sample and a multiethnic, multilingual population comprising many individuals of low socioeconomic status and education level At least twice as fast as the Mini-Mental State Examination. Less affected by subject ethnicity, language, and education, and can detect a variety of different dementias Many people with mild cognitive impairment (cognitive impairment too mild to meet diagnostic criteria for dementia)

11 Training Implementation & Evaluation of a Depression Care Model (DCM) for the Homebound Elderly - Training program by R. Madden-Baer Depression Care for Patients at Home (Depression CAREPATH: Intervention Development and Implementation, Part 1; Home Healthcare Nurse: July/August 2011 Volume 29-Issue 7 p Depression Care for Patients at Home (Depression CAREPATH): Home are Depression Care Management Protocol, Part 2; Home Healthcare Nurse: September 2011 Volume 29 Issue 8-p

12 Training Part 2 Training nursing staff to recognize depression in home healthcare (Brown, 2010) describes the training in the assessment of depression (TRIAD) intervention to more effectively identify depression and refer cases for treatment. Training clinical staff in home health in the identification and management of patients with depression Rose Madden-Baer

13 Patient Handouts: What is Depression?

14 Patient Handouts: Process for Managing Depression

15 Measurement OASIS process measure for Depression Screening (M1730) Pre- and post-scores on GDS or PHQ-9 for patients whose initial PHQ-2 was 3 or more and who received additional screening and follow up interventions

16 Helpful Hints Managing depression is similar to managing other chronic conditions (Bruce, July/August 2011) The role of the home care nurse should include (1) symptom assessment; (2) case coordination; (3) medication management, (4) education of patients and families, and (5) patient goal setting. (Bruce, July/August 2011) Build tools in EMR if possible

17 Helpful Hints Part 2 Call PCP with specific results of screening tools Dementia symptoms can be impacted by depression and the improvement of dementia symptoms can be helped by treating depression