Common Mental Disorders Depression - New Zealand Doctor

Chapter 2 Principles of intervention in the primary care setting
providing psychological therapies who are members of a recognised professional
organisation with documented ethical guidelines, professional conduct procedures
and requirements for supervision.
In New Zealand, general practitioners often focus on the diagnosis and treatment
of illness, while the practice nurse role has evolved to include preventative activities,
health maintenance and management of long-term disorders. 140 In the general
practice setting, there is no good evidence that outcomes differ according to whether
care is led by the general practitioner or the practice nurse. 65,141 General practitioners
and practice nurses working collegially and collaboratively could share the
management of patients with depression and utilise their differing skills to the benefit
of patients. 140,142 The literature strongly advocates the use of interdisciplinary teambased
models of care as a cost-effective way of improving primary care outcomes for
patients with depression. The practice nurse and general practitioner working together
could share the tasks involved in the management of patients with depression, such
as screening, diagnosis, treatment intervention, patient education, self-management
support, monitoring of progress and concordance with treatment, relapse-prevention
planning and liaison with other team members. These activities can be undertaken by
a mix of face-to-face and other means (eg, telephone, text or email). 142
Structural changes arising from the implementation of the Primary Health Care Strategy
are increasing the potential for New Zealand practice nurses to undertake an expanded
role. Despite ongoing challenges concerning funding and employment arrangements,
a professional infrastructure is now developing and there are growing opportunities for
professional development. These changes will increase the capacity for practice nurses
to work effectively and collaboratively within a general practice team. 140
2.5 Managing depression:
shared decision-making
Successful management of depression is far more likely if the patient is an active
participant in the care process. 143 A collaborative partnership between the practitioner
and the patient is a consistent predictor of outcome regardless of the therapy used. 144-147
Integral to this partnership is an understanding between practitioner and patient on the
significance of depression and the tasks and goals of treatment. 136,145,148,149 The needs,
resources and cultural preferences of family and whänau should also be integrated
into the care plan, as they can provide the support networks that help facilitate patient
lifestyle changes and meet treatment goals. 150,151
In the view of the GDT, treatment for depression is generally ‘preference-sensitive’:
there is no one treatment that is clearly superior and so the best choice of treatment
depends not only on the benefits and risks of treatment options, but also on the
person’s lifestyle, values and preferences. In this situation the practitioner’s aim should
be shared decision-making, with an emphasis on informed patient choice as opposed
Identification of Common Mental Disorders and Management of Depression in Primary Care 19