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Depression Care for Patients at Home (Depression CAREPATH): Home Care Depression Care Management Protocol, Part 2

doi: 10.1097/NHH.0b013e31822cc1ab
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Depression Care for Patients at Home (Depression CAREPATH): Home Care Depression Care Management Protocol, Part 2


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GENERAL PURPOSE: To describe for registered professional nurses the clinical protocols developed as part of the Depression CAREPATH intervention to guide home care clinicians in the management of depression in their medical and surgical patients.

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

  1. Explain the use and implementation of the home care depression care protocol presented here.
  2. Plan the appropriate strategies for managing depression according to the protocol.

1. In the Depression CAREPATH for home healthcare, who is expected to manage depression as part of the routine care provided to their patients?

a. physical therapists

b. clinical nurse specialists

c. all primary clinicians in the agency

d. consulting psychiatric professionals

2. It is the responsibility of each home health agency that uses the Depression CAREPATH to

a. make periodic updates to the protocol.

b. provide data for ongoing research efforts.

c. train consultants to implement the protocol.

d. specify their own guidelines for case coordination.

3. It is recommended that agencies use the PHQ-2 option to screen for depression because it includes the two "gateway symptoms" of depression, one of which is

a. suicidal thoughts.

b. little interest or pleasure in doing things.

c. alterations in sleep patterns.

d. impaired ability to concentrate or focus.

4. What should home health care clinicians do next after a patient screens positive for depressive symptoms on the PHQ-2?

a. Assess the patient with the full PHQ-9 to determine depression severity.

b. Repeat the PHQ-2 with the patient and compare results.

c. Initiate depressive care management for the patient.

d. Consult a mental health nurse specialist.

5. Which of the following is the score from the PHQ-9 over which the patient is identified as having clinically significant depression?

a. 4

b. 6

c. 8

d. 10

6. What is the protocol for patients identified as having mild depression?

a. weekly PHQ-2 scores for two weeks

b. weekly PHQ-2 scores for three weeks

c. weekly PHQ-9 scores for two weeks

d. weekly PHQ-9 scores for three weeks

7. Clinicians should follow the Homecare Depression Care Management (DCM) protocol

a. twice a week.

b. weekly.

c. every three weeks.

d. once a month.

8. The purpose of depression assessment is to

a. identify the presence of depression.

b. make a formal diagnosis.

c. treat patients for depression.

d. initiate case management activities.

9. The expected first step following the initial DCM visit is

a. social services consultation.

b. case coordination.

c. medication reconciliation.

d. psychiatric referral.

10. The DCM protocol requires that clinicians re-contact the patient's physician or mental health specialist when

a. there have been no updates in case coordination for three weeks.

b. the patient starts taking a new medication.

c. the patient's depressive symptoms emerge or worsen.

d. there has been no change in the patient for two weeks.

11. With training, case presentations following the template the authors presented here usually take

a. less than two minutes.

b. three to four minutes.

c. about five minutes.

d. six to seven minutes.

12. The most effective treatments for depression in late life are antidepressant medications and

a. stress management.

b. lifestyle changes.

c. psychotherapy.

d. social support.

13. About how many geriatric home care patients are already taking an antidepressant medication at the start of care?

a. one in two

b. one in three

c. one in four

d. one in five

14. Most side effects of SSRIs and SNRIs

a. are not serious.

b. are persistent.

c. resolve in a few months.

d. appear a few weeks after the start of therapy.

15. It is usually recommended that antidepressant treatment last

a. at least three months.

b. six months after side effects resolve.

c. at least nine months.

d. a year or more after the acute phase.

16. Goal setting is particularly important in depression care as it serves a purpose that, in and of itself, has therapeutic value, which is to

a. plan for the future.

b. educate patients.

c. activate patients.

d. review medications.



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