Common Mental Disorders Depression - New Zealand Doctor

Chapter 9 Models of care
were reduced due to lower referral rates from primary care, with a higher volume
of patients being managed in the primary care setting. 546
Recent efforts to improve the management of specific long-term conditions in primary
care have moved towards a ‘chronic care model’. 547,548 This model entails organisational
change to identify and meet the needs of practice populations with long-term conditions,
evidence-based decision support, multidisciplinary approaches, links to community
resources and support for patient self-management. 150,343 In New Zealand, an adapted
model has been utilised that includes cultural competency and an increased emphasis
on the patient (plus their family and community). 549 Patient self-management includes
strategies such as reasonable problem-solving, realistic goal setting, symptom control,
relapse prevention and shared decision-making. 150
A recent systematic review suggests how the management of patients with depression
in primary care could benefit from a ‘chronic care’ approach, utilising the following
measures: 142
• registry of patients with a current or prior diagnosis of depression
• use of a guideline-based treatment algorithm in patient notes
• routine screening
• care manager (eg, practice nurse) monitoring of care
• interdisciplinary team care
• telephone monitoring
• general practitioner/practice nurse liaison with secondary care mental health
services
• individually developed care plan (Wellness Plan) for each patient
• increased support for patient self-management
• relapse prevention planning
• prepared visits with resources available in advance
• adequate preparation and ongoing education for all primary care staff.
9.3 Service delivery: special issues
for young people
A World Health Organization (WHO) review 165 discusses the increasing recognition
of barriers faced by young people in accessing health care for mental disorders.
These barriers include:
• reluctance to seek professional help
• inaccessibility of services (due to location, cost, hours, or lack of publicity/visibility)
• fear of stigma or lack of confidentiality
• ‘unhappy encounters’ with health professionals.
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