|Depression: Clinical Indicators|
|Diagnosis and initial management|
|Patients on the diabetes and/or CHD register who have been assessed for depression in the past 15 months using two standard screening questions||90||8|
|Assessment of severity at the outset of treatment in newly diagnosed patients (diagnosed preceding 1 April to 31 March)||90||25|
- The new depression disease area of the QoF offers practices 33 points, generating a payment of £4,111 in 2007/8 for the practice with average list size and prevalence.
- There are two indicators. The first indicator focuses on screening patients for depression who are also on the diabetes and/or CHD registers. The guidance says up to 33 per cent of patients develop depression after MI and there is a 24 per cent lifetime prevalence of co-morbid depression in diabetes mellitus.
- The second indicator focuses on patients with a new diagnosis of depression from April 2006. The indicator requires these patients to have an assessment of the severity of their depression at the outset of treatment.
- The guidance says about 2 per cent of those aged 16 to 65 suffer major depression, and mixed anxiety and depression is prevalent in a further 10 per cent of adults presenting in general practice.
- National prevalence rates for 2006/7 for England and Northern Ireland are 7 per cent and 6.5 per cent respectively. The nature of this indicator means this prevalence figure is not as straightforward as in other disease areas and is thought to indicate the percentage of patients eligible for depression screening.
Step 1: Assessing new patients
- You need to carry out a structured assessment of symptoms in all adults aged 18 and over with a new diagnosis of depression. The guidance suggests three assessment tools.
- Suggested assessment tools:
- Patient Health Questionnaire (PHQ-9)
- Beck Depression Inventory second edition (BDI-II)
- Hospital Anxiety and Depression Scale (HADS).
All are estimated to take three to five minutes to complete. Review the tools, decide which you will use and familiarise yourself and practice staff with it.
- Make sure you record in the patient’s notes that the patient has completed an assessment and which was used. Note that the date the assessment was added must be the same day or within a month after the diagnosis was added, not before.
- Note that women with postnatal depression are excluded from this indicator set.
Step 2: Screening those on the diabetes/CHD registers
- The other indicator in this set requires you to screen patients on the diabetes and/or CHD registers for depression every 15 months. It is suggested that this should be done at the patient’s annual review for diabetes or CHD.
- Practices need to make sure the standard questions below are included in reviews.
- The screening questions in the guidance come from NICE. They are:
- ‘During the past month, have you often been bothered by feeling down, depressed, or hopeless?'
- ‘During the past month, have you often been bothered by having little interest or pleasure in doing things?'
A ‘yes' to either question is considered a positive test and the guidance suggests that patients with a positive test are referred to the GP for assessment.
A ‘no' to both makes depression highly unlikely.
- If screening for depression is carried out by practice nurses during annual reviews for diabetes or CHD, consider whether any additional training will be needed and how this can be delivered.
Step 3: September to March
- Make sure patients with diabetes or CHD who have their annual reviews in secondary care do not fall through the net. These patients will be on the CHD or diabetes register and need to be screened for depression.
- Remember that your target patient group for new patients with depression will not be finalised until the end of the contract year (that is, 31 March 2008). For this reason, regular searches will be needed to make sure that all of the patients in this group have completed an assessment test.
Useful Resources for Depression
1. Beck Depression Inventory Second Edition (BDI-II)
Order online here
2. Hospital Anxiety and Depression Scale (HADS)
Order online here
3. National Institute for Health and Clinical Excellence (NICE)
4. Patient Health Questionnaire (PHQ-9)