Abstract
BackgroundIn the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.MethodsThis is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.ConclusionThe strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.
Highlights
In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes
There is evidence that the presence of depression in patients with CHD or type 2 diabetes mellitus (T2DM) leads to increased morbidity and mortality [7,8], but co-morbid depression is often missed in routine consultations within general practices [9]
One difficulty is that the traditional model used by general practices is one in which visits to the general practitioner (GP) are initiated by patients when they feel that their needs warrant a consultation
Summary
In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. CHD already affects over 300,000 people in Australia and remains the most common cause of death [6] Both diabetes and heart disease are associated with a number of serious complications, each with its own cost. One difficulty is that the traditional model used by general practices is one in which visits to the general practitioner (GP) are initiated by patients when they feel that their needs warrant a consultation. Such visits are usually episodic and cease when the immediate symptoms are relieved. Such patients miss out on regular monitoring of their chronic disease so that risk factors go unrecognised [9]
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