Depression Care Management

Assess for Depression

Red flags:

  • Chief complaint of sleep disturbance, fatigue, appetite or weight change
  • Chronic pain
  • Chronic illness(es)
  • Recent major stress or loss
  • Multiple unexplained symptoms
  • History of depression

If your patient has one or more of these red flags ask the patient these two questions:
* During the past month, have you often been bothered by little interest or pleasure in doing things?
* Have you been feeling down, depressed or hopeless?

If your patient answers yes to one or both of these questions ask the patient to complete the PHQ-9 form.

The PHQ-9 is an easy but powerful tool to assist healthcare professionals in providing evidence-based care to their depressed patients. Many healthcare professionals who suspect depression ask the patient to complete the free-of-charge PHQ-9 during a break and simply hand-score it before resuming the visit. The PHQ-9 score gives healthcare professionals a tentative diagnosis, identifying patients who need to begin active treatment for the condition. The PHQ-9 also gives healthcare professionals a severity score to monitor treatment response over time.

pdf icon Download the PHQ-9 Form

Determine Eligibility

Studies show that patients who have a PHQ-9 score of 12 or higher meet diagnostic criteria for major depression 85% of the time. Other studies show that patients who meet PHQ-9 depression criteria achieve significantly better outcomes with depression care management. The office nurse can assist the patient in determining whether the patient’s benefit plan includes Depression Care Management by reviewing our Depression Care Management Vendors Chart. If the patient's benefits do not cover this service, your office can treat and monitor the condition without assistance or the office nurse can refer the patient to a self-pay program.

  • Refer depressed patients to care management.
  • Determining whether the patient has the benefit or can self-pay
  • Contacting vendors
  • Referral dialogue

Treatment Recommendations (pdf icon Printable PDF)

Overview of Treatment for Depression

Query patient about preferred treatment (antidepressant medication or behavioral counseling).

If patient prefers antidepressant medication:

  • Select and initiate antidepressant medication
  • Educate patients on the rules of antidepressants (distribute attached handout).

Rules of Antidepressants (pdf icon Printable PDF)

  • Antidepressants don’t work suddenly. Benefit comes on slowly, may take a few weeks.
  • Antidepressants only work if you take them everyday.
  • Antidepressants are not addictive.
  • Side effects are usually mild and get better with time.
  • After you feel better, you must continue to take them for at least four months to reduce the risk of depression returning.
  • Call your healthcare professional before discontinuing use.

Overview of Medication for Depression

 

If patient prefers behavioral counseling*

  • Office nurse and patient identify behavioral counseling providers covered under patient’s health insurance who are accepting new patients
  • Office nurse instructs patient on making an appointment with behavioral counseling provider.
  • Office nurse healthcare professional calls patient in two weeks to assure patient has completed referral
  • Healthcare provider assesses patient response to behavioral counseling in 12 weeks
  • Healthcare provider suggests adding antidepressant medication to patients who do not report a full response to behavioral counseling in 12 weeks.

*Short-term behavioral counseling has been shown to be just as effective as antidepressant medication in treating mild to moderate cases of depression.

How Depression Care Management Reduces Employee Suffering

The following graphs show how Depression Care Management increases remission and reduces emotional impairment over a two-year period compared to the care patients generally receive.

Remission Depressed patients are determined to be in remission when they no longer report a period of two weeks where they feel A) down, depressed, or hopeless or B) little interest or pleasure in doing things.

Emotional Impairment Days

Emotional impairment days are days when an individual’s emotional problems are so severe that s/he has to cut back on normal activities by at least a half day or stay in bed. Depression Care Management reduces the emotional impairment days each individual suffers by an average of 31.0 days each year over usual care.