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Depression Care for Patients at Home (Depression CAREPATH): Intervention Development and Implementation, Part 1

doi: 10.1097/NHH.0b013e3182266be9
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Depression Care for Patients at Home (Depression CAREPATH): Intervention Development and Implementation


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GENERAL PURPOSE: To present registered professional nurses with information on the development and implementation of Depression CAREPATH, an intervention for managing depression as part of ongoing care for medical and surgical patients.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

  1. Discuss the scope of the problem of depression among older home healthcare patients.
  2. Plan the appropriate strategies for implementing depression care management.
  3. Summarize the authors' findings and conclusions related to their depression care management project.

1. How many older patients in home healthcare meet full diagnostic criteria for major depression?

a. 1 in 8

b. 1 in 7

c. 1 in 6

d. 1 in 5

2. Depressive symptoms at the start of care generally

a. predict falls.

b. tend to be transient.

c. are not associated with suicidal ideation.

d. cause underutilization of healthcare services.

3. According to two of the authors' studies, how many symptomatic patients who take an antidepressant are taking sub-therapeutic doses?

a. one tenth

b. one quarter

c. one third

d. one half

4. In the primary care model, depression care management (DCM) is delivered by a designated "specialist," usually a nurse or a

a. psychiatrist.

b. social worker.

c. clinical psychologist.

d. occupational therapist.

5. In the Depression CAREPATH for home healthcare, the functions of DCM are assumed by

a. all agency RNs.

b. specially trained occupational therapists.

c. home health psychiatric nurses.

d. every primary clinician in the agency.

6. One of the five basic functions of the Depression CAREPATH is

a. patient goal setting.

b. care evaluation.

c. psychiatric referral.

d. timely intervention.

7. To be effective, depression care management should look, feel, and sound like

a. case coordination.

b. routine practice.

c. discharge planning.

d. direct supervision.

8. As part of DCM, clinicians should be prepared to

a. identify cases that need further evaluation.

b. influence families' decision making.

c. treat patients for mild depression.

d. make treatment decisions about depression.

9. The greatest risk factor for suicide in late life is

a. medical comorbidities.

b. death of a spouse or partner.

c. dementia.

d. depression.

10. A home health clinician who first identifies clinically significant depressive symptoms should

a. administer psychiatric tests.

b. contact the patient's physician.

c. perform a medication review.

d. refer the patient to a mental health clinic.

11. Exclusion criteria for patients in the authors' field testing of the Depression CAREPATH with local agency partners was a diagnosis of

a. delirium.

b. bipolar disorder.

c. agoraphobia.

d. posttraumatic stress disorder.

12. Based on their field testing of the Depression CAREPATH, the authors identified an overall rate of major depression of

a. 4.5%.

b. 10.2%.

c. 14.5%.

d. 20.2%.

13. Using the DCM protocol, the participating agencies achieved a reduction in depressive symptoms of

a. 20%.

b. 30%.

c. 40%.

d. 50%.

14. What percentage of patients with symptoms of minor depression also improved?

a. 40%

b. 50%

c. 60%

d. 70%

15. When the authors compared the discharge OASIS among DCM patients to 193 similarly depressed patients receiving usual care, how much more likely were the usual care patients to remain depressed?

a. 10%

b. 25%

c. 33%

d. 50%.

16. During the evaluation process, the agency nurses reported a benefit that transcended depression care, which was

a. communicating more effectively with physicians.

b. becoming more consistent with documentation.

c. learning new strategies for patient education.

d. understanding their own psychological issues.



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