S Iliffe

Training General Practitioners in the Identification and Management of Adolescent Depression within the Consultation: A Feasibility Study.

BACKGROUND Depressive disorders are common in adolescent general practice attenders. METHOD Adolescent attenders were screened/interviewed for depressive disorders, general practitioners (GPs) completed a checklist indicating recognition of psychopathology prior to and following GP training in the identification/management of adolescent depression. RESULTS One hundred and thirty consecutive adolescent attenders were screened before and 184 after training. Ten GPs completed the training. Psychiatric interviews with 38 adolescents with high depressive scores prior to and 44 following training identified 10 (26%) and 21 (48%), respectively, as clinically depressed. Sensitivity of GP identification improved from 2/10 (20%) to 9/21 (43%) without loss of specificity; predictive validity from 2/6 (33%) to 9/12 (75%). Adolescents interviewed appreciated the intervention. CONCLUSIONS Training GPs is feasible and may improve recognition of adolescent depression.

Recognising and responding to adolescent depression in general practice: Developing and implementing the Therapeutic Identification of Depression in Young people (TIDY) programme

Rates of depressive disorder in adolescents attending primary care are increasing. Most presentations are for physical complaints and concurrent depressive symptoms go unrecognised and untreated. Primary care practitioners describe reluctance to intervene due to lack of confidence and skills. This paper describes the development and implementation of TIDY (Therapeutic Identification of Depression in Young people), a programme designed by child psychiatrists and general practitioners to improve detection and intervention for depression within ordinary consultations. The paper describes the integration of educational principles and current evidence into the development of the training programme and the intervention package. The content of the intervention is described. For cases of mild to moderate depressive disorder, where patients do not require referral for specialist treatment, practitioners are trained to deliver self-help and coping strategies within a single consultation.

Nurse-led case management for community dwelling older people : An explorative study of models and costs

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.

Training on dementia for emergency ambulance staff: research agenda and opportunities

(Larner and Hancock 2014) showed a small net loss ( 0.13) for m-ACE versus MMSE (at cutoff ≤24/30) for dementia diagnosis, with an equivalent increase of 22 cases of dementia detected per 1000 tested, but a large net benefit for MCI diagnosis (0.38) with an equivalent increase of 133 cases of MCI detected per 1000 tested. At the cutoffs specified in the index paper, for dementia diagnosis (Table 1, left hand columns), m-ACE was very sensitive (1.00, 0.92) but not very specific (0.28, 0.61); sensitivity and specificity for MMSE (cutoff ≤24/30) were 0.92 (surprisingly high) and 0.72. For MCI diagnosis (Table 1, right hand columns), m-ACE was both sensitive (0.77) and specific (0.82) at the lower cutoff; figures for MMSE (cutoff ≤24/30) were 0.54 and 0.86. This study showed that m-ACE is quick, easy to use and score, and acceptable to patients. At prespecified cutoffs, its performance for dementia diagnosis was comparable with MMSE and better for diagnosis of MCI. In summary, m-ACE appears to be an acceptable alternative to MMSE for the initial assessment of cognitive complaints in a dedicated cognitive disorders clinic. Conflict of interest

Collaboration to overcome barriers in primary care

Thapar and colleagues’ review of managing and preventing depression in adolescents highlights primary care’s role in detection and initial management and alludes to pragmatic psychosocial approaches.1 However, attempts to increase the involvement of primary care are impeded by concerns about medicalising depression, which means that psychological problems are not explored even when …

Nurse-led case management for community dwelling older people: an explorative study of models and costs: Nurse-led case management

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.

Nurse-led case management for community dwelling older people

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.