Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings

International Journal of Mental Health Systems

Ross Bailie⁴  Alex Brown¹  Christine Connors²  Damin Si³  Tricia Nagel⁴  Gill Schierhout⁴ 

[1] Baker IDI, Central Australia, Alice Springs, Australia;Northern Territory Department of Health, Darwin, Australia;Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Australia;Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia

关键词: Indigenous health services;    Quality improvement;    Depression;    Type 2;    Diabetes mellitus;   

Others  :  801588
DOI  :  10.1186/1752-4458-7-16

 received in 2013-03-19, accepted in 2013-05-30,  发布年份 2013

【 摘 要 】

Background

Relatively little is known about how depression amongst people with chronic illness is identified and managed in diverse primary health care settings. We evaluated the role of complex physical needs in influencing current practice of depression screening, documentation and antidepressant prescriptions during a 12-month period, among adults with Type 2 diabetes attending Aboriginal and Torres Strait Islander primary care health centres in Australia.

Methods

We analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative, using previously reported standard sampling and data extraction protocols. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months. We compared current practice in depression screening, documentation and antidepressant prescription between patients with different disease severity and co-morbidity. We used random effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre.

Results

Among the 1174 patients with diabetes included, median time since diagnosis was 7 years, 19% of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease. Some 70% of patients had HbAc1>7.0%; 65% had cholesterol >4.0 mmol1-1 and 64% had blood pressure>130/80 mmHg. Documentation of screening for depression and of diagnosed depression were low overall (5% and 6% respectively) and lower for patients with renal disease (Adjusted odds ratio [AOR] 0.21; 95% confidence interval [CI] 0.14 to 0.31 and AOR 0.34; 95% CI 0.15 to 0.75), and for those with poorly controlled disease (HbA1c>7.00 (AOR 0.40; 95% CI 0.23 to 0.68 and AOR 0.51; 95% CI 0.30 to 84)). Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment. Antidepressant prescription was not associated with level of diabetes control or disease severity.

Conclusions

Background levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity. Strategies to improve depression care for vulnerable populations are urgently required. An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care.

【 授权许可】

   
2013 Schierhout et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Li C, Ford ES, Zhao G, Ahluwalia IB, Pearson WS, Mokdad AH: Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: The Behavioral Risk Factor Surveillance System, 2006. Diab Res Clin Prac 2009, 83:268-279.
• [2]Nimalasuriya K, Compton MT, Guillory VJ: Screening adults for depression in primary care: A position statement of the American College of Preventive Medicine. J Family Prac 2009, 58:535-538.
• [3]Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Inter Med 2009, 151:784-792.
• [4]Standard Treatment Manual CARPA: 5th edn. Alice Springs: Central Australian Rural Practitioners Association; 2009.
• [5]NACCHO/RACGP: National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edition. South Melbourne: The RACGP; 2012.
• [6]National Institute of Health and Clinical Excellence: Quick Reference Guide. Developing the clinical and health improvement indicators for the Quality and Outcomes Framework (QOF). http://www.nice.org.uk/media/750/E1/QOFQRGLRFinal.pd webcite
• [7]Guidelines for preventive activities in general practice. 7th edition. East Melbourne: Royal Australian College of General Practitioners; 2009.
• [8]Kitson A, Straus SE: The knowledge-to-action cycle: identifying the gaps. CMAJ 2010, 182:E73-E77.
• [9]Dingwall KM, Cairney S: Psychological and cognitive assessment of Indigenous Australians. Aust NZ Psych 2010, 44:20-30.
• [10]Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S: Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 2010, 8:348-353.
• [11]Reddy P, Philpot B, Ford D, Dunbar JA: Identification of depression in diabetes: the efficacy of PHQ-9 and HADS-D. Br J Gen Pract 2010, 60:239-245.
• [12]Esler D, Johnston F, Thomas D, Davis B: The validity of a depression screening tool modified for use with Aboriginal and Torres Strait Islander people. Aust NZ Public Health 2008, 32:317-321.
• [13]Esler DM, Johnston F, Thomas D: The acceptability of a depression screening tool in an urban, Aboriginal community-controlled health service. Aust N Z J Public Health 2007, 31:259-263.
• [14]Australian Institute of Health and Welfare: Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. Cat. no. IHW24. Canberra: AIHW; 2009.
• [15]Schlesinger CM, Ober C, McCarthy MM, Watson JD, Seinen A: The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk. Drug Alcohol Rev 2007, 26:109-117.
• [16]Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L: The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med 2000, 9:150-154.
• [17]Fenton JJ, Von Korff M, Lin EHB, Ciechanowski P, Young BA: Quality of Preventive Care for Diabetes: Effects of Visit Frequency and Competing Demands. Ann Fam Med 2006, 4:32-39.
• [18]Spann SJ, Nutting PA, Galliher JM, Peterson KA, Pavlik VN, Dickinson LM, Volk RJ: Management of Type 2 Diabetes in the Primary Care Setting: A Practice-Based Research Network Study. Ann Fam Med 2006, 4:23-31.
• [19]Lustman PJ, Penckofer SM, Clouse RE: Recent advances in understanding depression in adults with diabetes. Curr Psych Reports 2008, 10:495-502.
• [20]Talbot F, Nouwen A: A review of the relationship between depression and diabetes in adults: is there a link? Diab Care 2000, 23:1556-1562.
• [21]Black SA, Markides KS, Ray LA: Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diab Care 2003, 26:2822-2828.
• [22]de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ: Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001, 63:619-630.
• [23]Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, Blais MA, Meigs JB, Grant RW: Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diab Care 2007, 30:2222-2227.
• [24]Bailie R, Si D, Connors C, Weeramanthri T, Clark L, Dowden M, O'Donohue L, Condon J, Thompson S, Clelland N, et al.: Study protocol: Audit and Best Practice for Chronic Disease Extension (ABCDE) Project. BMC Health Serv Res 2008, 8:184. BioMed Central Full Text
• [25]Diabetes management in general practice: guidelines for type 2 diabetes (2011/2012). Diabetes Australia and RACGP; 2011. Available at http://www.racgp.org.au/your-practice/guidelines/diabetes/ webcite [verified 2 June 2013]
• [26]Si D, Bailie R, Dowden M, Kennedy C, Cox R, O'Donoghue L, Liddle H, Kwedza R, Connors C, Thompson S, et al.: Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia. Diab Metab Res Rev 2010, 26(6):465-473.
• [27]Katon WJ, Simon G, Russo J, Von Korff M, Lin EHB, Ludman E, Ciechanowski P, Bush T: Quality of Depression Care in a Population-Based Sample of Patients With Diabetes and Major Depression. Med Care 2004, 42:1222-1229.
• [28]Subramanian DNHK: An audit of the first year of screening for depression in patients with diabetes and ischaemic heart disease under the Quality and Outcomes Framework. Qual Prim Care 2008, 16:341-344.
• [29]Baik S-Y, Gonzales JJ, Bowers BJ, Anthony JS, Tidjani B, Susman JL: Reinvention of depression instruments by primary care clinicians. Ann Fam Med 2010, 8:224-230.
• [30]Nutting PA, Rost K, Smith J, Werner JJ, Elliot C: Competing demands from physical problems: Effect on initiating and completing depression care over 6 months. Arch Fam Med 2000, 9:1059-1064.
• [31]Osborn CY, Trott HW, Buchowski MS, Patel KA, Kirby LD, Hargreaves MK, Blot WJ, Cohen SS, Schlundt DG: Racial Disparities in the Treatment of Depression in Low-Income Persons With Diabetes. Diab Care 2010, 33:1050-1054.
• [32]Hunter E: Disadvantage and discontent: A review of issues relevant to the mental health of rural and remote Indigenous Australians. Aust J Rural Health 2007, 15:88-93.
• [33]Nagel T, Robinson G, Condon J, Trauer T: Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of a mixed methods study. Aust J Rural Health 2009, 17:174-182.