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Mercy Health starts pilot to screen patients for depression

Hamilton Journal News (OH) - 10/19/2014

Oct. 19--The Mercy Health system has a new pilot program underway at a primary care office to screen all adult patients for depression.

The Springdale Family Medicine office just last week started a year-long pilot of using a patient health questionnaire to screen all patients 18 and older for signs of depression.

"Over the last two to three years, we've increased understanding in the medical community of the problems depression can have with co-morbid conditions," said Dr. Randy Curnow, vice president of medical affairs for Mercy Health Physicians. "There's evidence of the effect on diabetes, heart disease, respiratory conditions," as well as impact to loved ones and the greater economy.

The pilot in Springdale is an expansion on a program started last November at more than 50 Mercy Health primary care offices in Greater Cincinnati to screen patients 65 and older for depression.

Americans are at a 17 percent to 20 percent lifetime risk for a major depressive episode, according to Curnow.

"The hope is we create better processes ... and increase awareness on the issue," Curnow said. "The goal is to have better treated and better diagnosed depression so the patient gets better care and outcomes."

Depression is a common co-occurring disorder that can decrease a patient's compliance with rehabilitation efforts, lifestyle change and medications, said Dr. Erik Nelson, associate professor of psychiatry and behavioral neuroscience at University of Cincinnati College of Medicine.

Nelson said research shows higher rates of depression in patients with cardiac illnesses such as heart attack, endocrine illnesses affecting thyroid, and neurological disorders including Alzheimer's disease and stroke.

"Depression does increase time to recovery and decrease chance for full recovery from heart attack and stroke," Nelson said.

Curnow said Mercy Health will study the pilot results from Springdale Family Medicine over the next eight months to determine success and sustainability before rolling it out across Mercy Health's seven geographic markets in Ohio and Kentucky.

"We realized a connection between mind, body and spirit is something we can't overlook," said Dr. Erin Fries, primary care doctor at Springdale Family Medicine.

Patients are now asked two questions about their level of interest or pleasure in doing things and if they're feeling down, depressed or hopeless. Depending on a patient's score, they are asked an additional seven questions to further identify depression.

The Springdale practice is the only Mercy Health location so far to have both an embedded psychologist and psychiatrist to address the depression.

"Medication and talk therapy are very helpful together; it's very synergistic," Fries said.

Nikki Instone, behavioral health consultant, has been working at the Springdale location for a month and a half. After a patient's regular primary care check up they can immediately have a visit with Instone if they were identified on the depression screening.

"It uncovers those patients you think are doing great," Fries said. "It's uncovered a huge number of patients that would have been missed."

Instone holds "brief, solution-focused" visits with the patient and has the goal of getting them better within eight, 30-minute visits. Instone collaborates with the patient to identify a list of things they can do at home, and offers guidance, direction and support in follow-up visits.

In the hospital setting, Atrium Medical Center in Middletown and West Chester Hospital are among those to screen patients for depression upon admittance to the hospital.

"If the nurse identifies depression, they notify the physician and collaborate with social work for discharge planning," said Cassy Jonas, nurse manager in the intensive care unit at West Chester Hospital.

Jonas said she notices depression occurring more in patients with end-stage diseases that require constant maintenance such as daily dialysis.

"It's a constant interruption in their life," Jonas said.

The hospital will coordinate with the Council on Aging of Southwestern Ohio's Care Transitions program to provide the patient with a home visit following discharge from the hospital, said Amber Finkelstein, social worker at West Chester Hospital. This helps to ensure the patient is complying with discharge instructions.

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(c)2014 the Journal-News (Hamilton, Ohio)

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