Theory in practice: Helping providers address depression in diabetes care *

Abstract

Introduction A Continuing Education (CE) program based on the theory of planned behavior was designed to understand and improve health care providers’ practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods Participants completed assessments of attitudes, confidence, intentions, and behaviors regarding depression management at three time points: immediately prior to the CE program (baseline), immediately after the CE program (posttest) and six-weeks after the CE program (follow-up). Results Ninety eight providers attended the CE program; 71 completed the baseline assessment; 66 completed the posttest assessment, and 37 completed the 6-week follow-up. Compared to baseline, at posttest providers reported significantly more favorable attitudes, fewer negative attitudes, greater confidence, and greater intention to address depression with their diabetes patients. At six weeks follow-up, there was a marginally significant increase in educating patients about depression, but no other depression management practices changed. Intention to change and confidence predicted some depression practice patterns at follow-up. Fewer barriers were a consistent predictor of depression practice patterns at follow-up. Discussion In the short-term, provider attitudes, confidence, and intentions to address depression with their patients improved. Intention, confidence, and especially barriers are important intervention targets. Lessons for Practice Depression is a common comorbidity of diabetes. Healthcare providers must be better prepared to manage depression in their diabetes patients. Educating health professionals is one approach to improving depression care. Healthcare systems must address barriers to providers’ efforts to manage depression. Continuing education programs should aim to enhance providers’ intentions, confidence, and skills to overcome barriers to addressing depression in clinical care.

Painful Diabetic Neuropathy is More than Pain Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators

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“…14 Unfortunately, in a study that examined 71 health care providers' approaches to screening and treating patients with type 2 diabetes for depression, only half reported ever using a depression screening tool in their practice. 28 Limited training may be one reason providers do not address the mental health issues of their patients with diabetes. Also, providers may consider psychosocial concerns to be out of their area of expertise, which can influence whether they screen or refer patients for mental health consultations.…”

“…24 All providers experience competing demands for their limited time with patients, which makes it difficult to conduct mental health assessments. 28 Providers caring for patients with diabetes may also have trouble distinguishing somatic symptoms of depression or diabetes distress from symptoms of physical illness, which can make it hard to provide an accurate diagnosis. 29 Barriers to screening for depression and diabetes distress also exist at the practice level.…”

“…If a practice does not have access to mental health specialists, mental health screening tools, or a reminder system to alert providers to screen for mental health conditions on a routine basis, depression and diabetes distress may go undetected. 14,28…”

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“…It would be appropriate to design and test proper continuing education and training programs for healthcare providers to improve their practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment (Meeuwissen, Holleman, de Jong et al. ; Osborn, Kozak, & Wagner, )…”