Depression Screening and Interventions for Older Home Health Care Patients

Delaney, Colleen; Fortinsky, Richard H.; Doonan, Lorraine; Grimes, Rita; Pearson, Terra-Lee; Rosenberg, Suzanne; Bruce, Martha L.

doi:10.1177/1084822311405459

Cited by 13 publications

(4 citation statements)

References 27 publications

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“…These approaches may be particularly applicable in low-resource environments with known human resources limitations and in scenarios in which stigma or attitudinal barriers are concerns. Such programs have yielded promising results across an array of disability-related challenges (Delaney et al, 2011;Marks, Sisirak, & Chang, 2013).…”

Section: Societal Processes Within and Between Countriesmentioning

confidence: 99%

Disability-related global health needs.

Bentley¹,

MacLachlan²,

Geiser³

et al. 2019

Handbook of Rehabilitation Psychology (3rd Ed.).

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The World Report on Disability (World Health Organization [WHO] & World Bank, 2011) has major implications for rehabilitation psychology (MacLachlan & Mannan, 2014). The report noted a paradigm shift away from the "medical" model and toward a social and rights-based approach. It also provided a summary of evidence to suggest that disability is highly prevalent and is increasing, is extremely diverse, and disproportionately affects vulnerable populations and poor people. Moreover, the report has highlighted that people with disabilities face widespread barriers to accessing services and have worse health and socioeconomic outcomes than the general population. Findings associated with disability occur globally; however, the nature and extent of disability may differ across contexts. Disability varies in relation to contextual factors, but several patterns of influential social factors that determine their occurrence are similar (see Chapter 26, this volume).Recognition of social and contextual factors influencing functional status and outcomes is one of the distinguishing features of global health. Indian psychologists Awasthi, Yadava, and Pandey (2016) recognized that disability is a global health concern. They argued that "the prevalence of disability, rehabilitation awareness, education, accessibility and availability of rehabilitation services are the greatest challenge for the development of society as well as the country" (p. 196). Although context is integral to understanding disability, this chapter focuses on common factors relevant to disability and its intersection with global health.According to the global health movement, disorder and disability are seen as being similarly patterned with distinct local settings and living conditions that influence how such disabilities are experienced and expressed (MacLachlan, 2006). The idea of the "right to health" (i.e., the right to access health care appropriate to one' s needs) is consistent with another hallmark of the global health movement: a focus on social justice. As the social determinants of health are broadly distributed, this approach also sees a broad range of stakeholders as having a legitimate stake in global health (Commission on Social Determinants of Health, 2008;Koplan et al., 2009).The Commission on Social Determinants of Health (2008) has stated that a society should be judged by "how fairly health is distributed across the social spectrum" and how it protects people from disadvantage. The commission has recommended three broad action areas to achieve these goals: (a) improving the conditions of daily life-the circumstances under which people are born, grow, live, work, and age; (b) tackling the inequitable distribution of power, money, and resources; and (c) increasing resources to allow better measurement of the problem and evaluation of actions taken. Although psychology has certainly made important contributions to rehabilitation and global health, it often has done

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Section: Societal Processes Within and Between Countriesmentioning

confidence: 99%

Disability-related global health needs.

Bentley¹,

MacLachlan²,

Geiser³

et al. 2019

Handbook of Rehabilitation Psychology (3rd Ed.).

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“…This article reports the results of a cluster-based randomized effectiveness trial targeting depressive symptoms in Medicare Home Health patients. Medicare recommends depression screening and intervention for home health care patients, but interventions are needed that are clinically effective and feasible . The structure and practice of home health care pose challenges to this goal.…”

Section: Introductionmentioning

confidence: 99%

“…Medicare recommends depression screening and intervention for home health care patients, but interventions are needed that are clinically effective and feasible. [8][9][10][11][12][13] The structure and practice of home health care pose challenges to this goal. First, more than 97% of patients are referred for medical or surgical conditions and have multiple comorbidities.…”

mentioning

confidence: 99%

Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

et al. 2015

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IMPORTANCE Among older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. Feasible and effective interventions are needed to reduce this burden of depression.OBJECTIVE To determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than patients receiving enhanced usual care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized effectiveness trial conducted at 6 home health care agencies nationwide assigned nurse teams to an intervention (12 teams) or to enhanced usual care (9 teams). Between January 13, 2009, and December 6, 2012, Medicare Home Health patients 65 years and older who screened positive for depression on routine nursing assessments were recruited, underwent assessment, and were followed up at 3, 6, and 12 months by research staff blinded to intervention status. Patients were interviewed at home and by telephone. Of 502 eligible patients, 306 enrolled in the study. INTERVENTIONS The Depression Care for Patients at Home (Depression CAREPATH) trial requires nurses to manage depression at routine home visits by weekly symptom assessment, medication management, care coordination, education, and goal setting. Nurses' training totaled 7 hours (4 onsite and 3 via the web). Researchers telephoned intervention team supervisors every other week. MAIN OUTCOMES AND MEASURES Depression severity, assessed by the 24-item Hamilton Scale for Depression (HAM-D). RESULTSThe 306 participants were predominantly female (69.6%), were racially/ethnically diverse (18.0% black and 16.0% Hispanic), and had a mean (SD) age of 76.5 (8.0) years. In the full sample, the intervention had no effect (P = .13 for intervention × time interaction). Adjusted HAM-D scores (Depression CAREPATH vs control) did not differ at 3 months (10.5 vs 11.4, P = .26) or at 6 months (9.3 vs 10.5, P = .12) but reached significance at 12 months (8.7 vs 10.6, P = .05). In the subsample with mild depression (HAM-D score, <10), the intervention had no effect (P = .90), and HAM-D scores did not differ at any follow-up points. Among 208 participants with a HAM-D score of 10 or higher, the Depression CAREPATH demonstrated effectiveness (P = .02), with lower HAM-D scores at 3 months (14.1 vs 16.1, P = .04), at 6 months (12.0 vs 14.7, P = .02), and at 12 months (11.8 vs 15.7, P = .005). CONCLUSION AND RELEVANCEHome health care nurses can effectively integrate depression care management into routine practice. However, the clinical benefit seems to be limited to patients with moderate to severe depression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01979302

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“…Many CCM-based interventions for depression have trained providers on management of depression using specialists Ciechanowski et al, 2004;Unutzer et al, 2002). However, a "train-the-trainer model" has also been shown to be effective (Delaney et al, 2011). In this model, an expert trains a trainer who then goes on to train others.…”

Section: Training/educationmentioning

confidence: 99%

Testing the chronic care model for depression in homebound older adults.

Getz¹

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Depression Screening and Interventions for Older Home Health Care Patients

Cited by 13 publications

References 27 publications

Disability-related global health needs.

Disability-related global health needs.

Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

Testing the chronic care model for depression in homebound older adults.

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