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Depression
Workstream Overview
The Depression Workstream is focused on improving the treatment of depression within primary care. It has five key improvement objectives
Assessment
01 Improve support to Primary Care to enable the delivery of a holistic assessment for people presenting with symptoms of depression
Interventions
02 Improve evidence based prescribing and compliance with formulary
03 Improve access to non pharmacological interventions including:
- Evidence-based Psychological Therapies
- Self-help and Self Management
- Social Supports
04 Improve the understanding of staff, patients and carers of the different options for intervention
Review
05 Routinely monitor outcomes and modify services accordingly
what's happening
Depression
Local Delivery
The following are examples of work going on in Boards around these themes. We know there is much more happening out there - so if you have a piece of work you want featured, drop Rachna a line at
rachna.dheer@scotland.gsi.gov.uk
NHS Forth Valley
Have just completed the evaluation of Clackmannanshire pilot that ran from Aug 08 to July 09. The pilot increased the availability of Cognitive Behavioural Therapy alongside other evidence-based interventions to compliment the prescribing of antidepressants or as an alternative to prescribing antidepressants, including people aged over 65. It also aimed to support GPs in the appropriate prescribing of antidepressants in line with the Forth Valley Guideline for the Drug Treatment of Depression. The Pharmacists analysed prescribing trends pre-duringpost pilot to understand impact. Further information on the results of the pilot, and its planned roll-out, are available by contacting
Graham McLaren
Service Development Manager
graham.mclaren@fvpc.scot.nhs.uk
NHS Ayrshire and Arran
After using the Mental Health Collaborative's diagnostic toolkit to identify the top issues to be addressed in their area, NHS Ayrshire & Arran have conducted a baseline audit in three GP practices. These were chosen because of their differences in prescribing, deprivation and geography. The work involved a number of approaches - a questionnaire for staff within the practices on prescribing and management of people with depression, general profile questionnaires completed by Practice Managers and CMHT Team Leaders and the development, in collaboration with prescribing advisors, of a prescribing data extraction toll for use in GP Practices. A meeting in September with key stakeholders will decide how to progress the findings of this work and develop a service improvement action plan. For further information contact
Anne Gerard
Collaborative Manager
anne.gerard@aapct.scot.nhs.uk
Kes Khaliq
GP Clinical Lead
kkhaliq@doctors.org.uk
Lesley Sinclair
Senior Information Analyst
lesley.sinclair2@aapct.scot.nhs.uk
NHS Tayside
In March 09, Practice Pharmacists in Perth & Kinross CHP undertook an audit to determine how antidepressant drugs were initiated in General Practice. The objectives of the audit were to determine the percentage of patients prescribed an antidepressant drug for the first time who had a documented depression rating score at initiation of treatment, and to determine if the score indicated treatment with antidepressant medication. Compliance with the Tayside antidepressant prescribing formulary was also examined.
Results from 13 GP Practices indicated that 237 patients met the inclusion criteria and of those 153 (65%) had a rating score. Prescribing was supported by score in 61% of patients. Of the 237 patients to receive an antidepressant 23% received the first line drug (Fluoxetine) as indicated in the formulary, however over 90% were prescribed either fluoxetine or citalopram. Following presentations and targeted improvement work in each GP Practice, a second cycle audit will be undertaken in the autumn 2009. Further information can be obtained from
Lesley Anne Brown
Programme Manager
lesleyannebrown@nhs.net
Shirley Ward
shirley.ward@nhs.net
Audit of Prescribing
A range of Boards are currently involved in work to get a better understanding of local antidepressant prescribing. The Mental Health Collaborative will be facilitating a one off meeting to pull individuals together across Scotland who are involved in this work to share approaches. We will be circulating information shortly on dates.
Accessing Psychological Therapies Resource Pack
Mike Henderson (Consultant Psychologist, NHS Borders) is working with the Mental Health Collaborative to produce a resource pack on how to make the best use of current resources for psychological therapies.
This will include examples of work in various Boards across Scotland to reduce waiting times for psychological therapies. We are aiming to have a draft out to Boards for comments in the Autumn. If you have any examples of good practice in relation to improving access to psychological therapies then please do contact Mike directly at Mike.Henderson@borders.scot.nhs.uk .
If you can put 'Accessing Psychological Therapies Resource Pack' in title then this will help him to filter these emails out for attention.
Regional Events
During May we held an event in each region focused on delivering the Depression HEAT target. These had a particular focus on how to engage primary care in this work and also included each Board presenting on the work it is currently doing. Copies of these presentations can be accessed at
http://www.elib.scot.nhs.uk/SharedSpace/ist/Pages/Indexaspx?ContainerID=207651
There are a range of other national programmes focused on work that compliments that of the Collaborative. There is not space here to update on every other programme - but we will highlight one or two each newsletter.
Living Better
Living Better aims to improve the Mental Health and Wellbeing of people with diabetes and chronic heart disease. It is led by the Royal College of GPs, Scotland in partnership with the Scottish Development Centre for Mental Health and the University of Stirling. The project is funded by the Scottish Government. Research indicates that approximately one in three patients with diabetes and one in five patients with coronary heart disease experience depression. Further, there is evidence that providing treatment and support for depression and other emotional health problems can bring a range of physical and psychological benefits for this patient group. The following 5 Community Health Partnerships ( CHP) are participating in the project: Angus, Bellshill, East Dunbartonshire, South East Glasgow & Western Isles. Activities include assessments of patient and carer's needs, and working with GPs and other health professionals to develop new and improved support for patients. For further information please visit
www.livingbetter-scotland.org.uk
Keep Well
Keep Well is a free health check for people aged 45-64 who live in the 15% most deprived communities across Scotland. It involves simple checks for conditions like heart disease and has been successfully piloted across a number of Boards and all Boards have Keep Well type programmes. It is now being rolled out across all of Scotland. It's recently been agreed that this health check should be extended to cover issues of mental wellbeing. National guidance is being developed on what this should cover and additional funding has been identified to support implementation. Guidance will be circulated via Boards Health Improvement contacts and will advise local leads for Keep Well to link across to the Mental Health Collaborative Programme Managers to ensure any developments link to work already in place within primary care. If you want to find out more about this programme you can go its website at
www.keepwellscotland.com
There is a lot going on in the field of Depression at the moment. We have attempted to map out the different work nationally and how it links together. You can access this at http://www.elib.scot.nhs.uk/SharedSpace/ist/Pages/Index.aspx?ContainerID =207651 This is a working draft document, if you have any ideas on how to refine it then please contact rachna.dheer@scotland.gsi.gov.uk
Psychological Therapies Access Target The Scottish Government is currently scoping work around a Psychological Therapies Access target. This work is being led by the Mental Health Division and is currently looking at referral pathways and information systems to enable consideration of an access target for future years.
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