Deakin Rural Health

Mental Health

A Pragmatic Trial of Stepped Care Intervention for People with Depression and Cardiac Failure

This project examined the effectiveness of a stepped care model of treatment for people with co-morbid depression and cardiovascular disease. Depressive symptoms, quality of life, and physical and social functioning were examined. The efficacy of treatment and the enablers and barriers of effective treatment within the system were also studied.

Barwon South West Mental Health Mapping

This project looked at the provision of services for the high frequency psychological disorders, depression and anxiety, in the south west region of Victoria in the context of the increased priority being placed on mental health services by both the Australian and State governments. It also focussed on the experience of the consumer in accessing appropriate services.

The main aims were to:
1. Identify the capacity and structure of the current services available to those with depression and anxiety
2. Determine points of entry and service pathways from a consumer perspective
3. Identify service gaps, barriers and enablers to service utilisation
4. Analyse the impact of the new Medicare Benefits Schedule items on service usage and the mental health workforce
5. Propose recommendations to streamline service delivery through consultation with key stakeholders

The project was completed in December 2008.

Depression_Treatment Evaluation Care Team (D_TECT) (Chronic Disease Management of Co-morbid Depression, Heart Disease and Diabetes – Stage 1)

This project examined the clinical pathways for patients with co-morbid depression and diabetes using six general practices in the National Primary Care Collaboratives, which were required to set up chronic disease management systems with databases for recall. The project sought to determine where best to identify and intervene for patients with diabetes and depression.

Evidence-Based Best Practice Model Clinical Pathways for People with Co-Morbid Depression and Coronary Heart Disease

This project examined the clinical pathways for patients with heart disease across health care settings. It:
1. Explored the literature on prevalence, assessment and treatment of co-morbid depression and heart disease, as well as current activities of clinical pathways for these conditions
2. Process mapped the care provided to Coronary Heart Disease patients to identify basic elements and timeframes that are currently used to deliver patient care as well as problem points in the existing process
3. Identified best practice model clinical pathways for the Coronary Heart Disease patient group based on health provider interviews and patient discovery interviews
4. Informed the implementation of a pilot phase of clinical pathway in a general practice setting in the GGT region and guidelines for best practice in primary care settings for this patient group

This project was completed in May 2006.

The Mental Health Tertiary Curriculum Project

The Mental Health Tertiary Curriculum Project (MHTC) was funded by the Department of Health (DoH) through an agreement between DoH and the Australian Rural Health Education Network (ARHEN). The MHTC project had two aims targeted towards DoH’s objective to improve mental health services in regional, rural and remote Australia:
(i) to determine the distribution of current mental-health clinical placements, including the professional discipline, location and duration of placements, and
(ii) (ii) to determine the determinants, values, barriers and enablers that are specific to mental-health placements.
The study was undertaken by all eleven UDRHs, each examining mental-health placements within their local region.

TrueBlue (Chronic Disease Management of Co-morbid Depression, Heart Disease and Diabetes (National Project, Stage 2)

The TrueBlue project continued the development and evaluation of a system of primary care for patients with coronary heart disease (CHD) and/or type 2 diabetes and co-morbid depression. This project built on the successful work of the Depression_Treatment Evaluation Care Team (D_TECT) and Evidence-Based Best Practice Model Clinical Pathways for People with Co-Morbid Depression and Coronary Heart Disease projects.

The study is a randomised cluster design that compares the clinical outcomes between usual care and nurse-led collaborative care. Its pilot study D_TECT developed and tested the general practice-based model of chronic disease care for people with co-morbid depression, type 2 diabetes and/or chronic heart disease.

Specifically, the TrueBlue study:

1. Developed and tested a training program for general practitioners and practice nurses in the screening, assessment and management of depression in patients with type 2 diabetes and/or chronic heart disease.
2. Tested the feasibility of practice nurses to screen, assess, collect data, refer, review and monitor patients with co-morbid depression, type 2 diabetes and/or chronic heart disease.
Eleven general practices – five treatment and six control in the Northern Rivers area of New South Wales and in Adelaide (South Australia) – participated in the study. The study has completed its data-collection phase and the results are being prepared for publication. Anecdotal comments from the participating practice nurses suggest that TrueBlue has been well received by patients and nurses. Patients have noted, for example, “You get to talk to a practitioner a lot longer and in a much more relaxed atmosphere” or “If you write down goals and express them, it’s much more beneficial”. The study has also demonstrated a better adherence to best-practice guidelines for the management and monitoring of chronic heart disease and type 2 diabetes, including monitoring of depression.

TrueBlue is a collaborative project between beyondblue, the National Depression Initiative and the Australian Government Department of Health and Ageing.

Type 2 Diabetes and Depression: Assessing the Prevalence in Victoria and Identifying Effective Public Health Interventions

This project examined the extent of co-morbid depression (including depressive symptoms and disorders) among people with type 2 diabetes in ten General Practices throughout Victoria, and then made recommendations around the most effective public health interventions for the early detection and treatment of co-morbid depression among people with type 2 diabetes.

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