Chronic Condition and Care: Depression Essay
Depression is slowly but steadily growing into a noteworthy and consequential public health concern. The pathophysiology of depression is a little-understood area despite the extensive studies done. The pathophysiology of depression has been attributed to the decrease in the monoamine neurotransmitters such as serotonin, dopamine, and norepinephrine (Park & Zarate, 2019). Depression has greatly increased the occurrence of suicide. More than half of suicide cases are associated with depression (Park & Zarate, 2019). The prevalence of depression among the population continues to rise with an increase in the prevalence of chronic diseases such as diabetes and cancer (Almeida et al., 2020). This calls for a more spirited fight against depression through the involvement of more resources and taking the aspect of mental wellness seriously.
Incidence and Prevalence of Depression in the US
The prevalence of depression continues to rise exponentially among US citizens. In 2020, 8.4% (21 million) of the US adult population had at least an episode of major depression (National Institute of Mental Health, 2020). More females (10.5%) than males (6.2%) are affected by major depression. The young adult population is the most susceptible to depression. The estimated lifetime risk for depression stands at 30% in the US and remains one of the leading causes of mortality and disability (Park & Zarate, 2019). In the US, depression is ranked as the tenth leading cause of death and the third leading cause of disability worldwide (Park & Zarate, 2019). With these statistics, many programs to curb depression have been implemented in the US.
Diagnosis, Monitoring, and Treatment of Depression
Depression is often underdiagnosed. The diagnosis of depression is almost always based on the patient’s history and psychiatric evaluation. The diagnosis of depression is based on the Diagnostic Statistical Manual (DSM-V) criteria. The diagnosis is based on the presence of symptoms like depressed mood, anhedonia, sleep disturbances, decrease or increase in appetite, anergia, feelings of worthlessness, ideations of self-harm, suicidal thoughts, psychomotor retardation or agitation, and diminished ability to concentrate (American Psychiatric Association, 2013). The use of laboratory tests like complete blood count and thyroid function tests, among others can also support the diagnosis. Pharmacotherapy and psychotherapy remain to be major pathways in the treatment of depression. Continuous and long-term monitoring of depression patients is an important facet of the management of depression. This is because the depression symptoms tend to go in remission but may flare up with minimal provocation. Pedrelli et al. (2020) proposed a monitoring system for depression employing the use of smartphone and wristband sensors. With the high prevalence of relapse and sub-optimal outcomes despite standard treatment of depression, there is a need to establish a personalized monitoring and feedback follow-up protocol(Riese et al., 2021). Cognitive Behavioral Therapy (CBT) is one of the most efficacious psychotherapeutic treatments for major depressive disorder. When CBT is used in conjunction with pharmacotherapy, there is a major improvement in outcomes (Thase et al., 2018). The treatment of depression requires a multidisciplinary approach for the best outcomes.
Interdisciplinary Management and Coordination of Care
Lack of communication among professionals involved in the care of patients with depression is one of the significant challenges marring the efficiency of care. The collaborative care model comes in handy to fix this shortfall. The multidisciplinary approach to the management of depression has enabled the description of depression co-occurring with other illnesses and enabled the development of management protocols for better management (Almeida et al., 2020). As described earlier, depression commonly occurs with chronic diseases. The National Institute for Health and Care Excellence (NICE) recommends a multidisciplinary approach in the management of depression co-occurring with other chronic illnesses. Collaborative multidisciplinary care entails a multi-stepped integrated care system that deals with both mental and physical symptoms (Almeida et al., 2020). The team includes general practitioners, nurses, specialists, and mental health professionals.
The Role of APRN in the Management and Coordination of Care for Patients with Depression
Advanced practice nurses act as the face of health care. They are often the first to interact with patients seeking care for depression before the physicians (Norful et al., 2019). They can be co-managers in offering primary care. APRNs cover a wide range of care spanning from promoting health in the prevention of depression, diagnosis of depression, and care in the setting of depression. Nurse practitioners are highly efficient in the provision of care to patients with complex needs compared to their physician colleagues (Fraze et al., 2020). APRNs also ensure coordination of the process of care through their leadership role.
The Care Coordination Clinical Reasoning (CCCR) Systems Model of Management
Professional nurses have, since time immemorial, been the ones in charge of the coordination of care. In line with the health care reform, advanced practice nurses have sophisticated knowledge in the provision and coordination of care. The Care Coordination Clinical Reasoning Systems Model (CCCR) provides a seamless flow of patient-centered care, team-centered system, and organizational-centered thinking models that cumulatively enhance patient care. This care model provides the structures and blueprint to enhance critical and imaginative thinking, making the desired health outcomes in collaborative care achievable (Weaver et al., 2018). The skills that support care coordination include creative thinking, critical thinking, self-regulation perspectives, complexity thinking, and systems thinking. All these processes work to develop stronger relationships among the health care providers and between the health professionals and the patients (Weaver et al., 2018). Building such a relationship with patients is crucial in developing trust and ease of long-term follow-up.
The Cost of Management of Depression
The funding of California’s county-based system on mental health has significantly increased by 81% from 2010 to 2020. Orange county also saw the same magnitude of increase. Mental health management is now consuming a large chunk of the national budget.
Resources Available to Help Manage Costs of Care for Patients with Depression
The existence of several entities to champion the improvement in the management and care of patients with depression is encouraging. The national alliance of mental illness and the national suicide prevention lifeline, among others, are some of the community resources that have been put in place to cure depression effectively. Primary care providers and case managers also provide systematic support to people with mental illnesses. The continued increase in budgetary allocation in the management of mental health has also improved care by cutting down catastrophic expenditures. The inclusion of mental illness in the Medicaid and Medicare insurance schemes has also greatly cut down costs of the management of depression.
Challenges in the Management of Depression and How the Barriers Can be Overcome
There exists a myriad of barriers to the provision of efficient care to patients with depression. One of the major barriers is the shortage of mental health care personnel. This has greatly affected access and health seeking among patients with depression. The stigma surrounding mental illness has also been an impediment and greatly contributed to the widened mental health gap. Poor communication and a poorly coordinated approach in collaborative care have been a drawback. Overcoming these barriers requires a consultative systematic review of existing evidence and the development of effective treatment protocols through this evidence. Professional collaboration and effective communication is also a sure way to overcome impediments. Patient and care team education on matters of mental health is also a crucial strategy that can be employed to overcome the constant challenge of stigma.
Mental health remains a top priority for the US health sector. There is a need for individualized patient-centered care in the clearance of the depression menace. Healthcare providers must now brace and collaborate with the relevant personnel to make sure the population gets quality services.
Almeida, S. S., Zizzi, F. B., Cattaneo, A., Comandini, A., Di Dato, G., Lubrano, E., Pellicano, C., Spallone, V., Tongiani, S., & Torta, R. (2020). Management and treatment of patients with major depressive disorder and chronic diseases: A multidisciplinary approach. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.542444
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th edition). Reference Reviews, 28(3). https://doi.org/10.1108/rr-10-2013-0256
Fraze, T. K., Briggs, A. D. M., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs. Medical Care, 58(10), 853–860. https://doi.org/10.1097/MLR.0000000000001364
National Institute of Mental Health, (2020). Major depression, National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/major-depression
Norful, A. A., Swords, K., Marichal, M., Cho, H., & Poghosyan, L. (2019). Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care: The promise of a new delivery care model to improve quality of care. Health Care Management Review, 44(3), 235–245. https://doi.org/10.1097/hmr.0000000000000161
Park, L. T., & Zarate, C. A., Jr. (2019). Depression in the primary care setting. The New England Journal of Medicine, 380(6), 559–568. https://doi.org/10.1056/NEJMcp1712493
Pedrelli, P., Fedor, S., Ghandeharioun, A., Howe, E., Ionescu, D. F., Bhathena, D., Fisher, L. B., Cusin, C., Nyer, M., Yeung, A., Sangermano, L., Mischoulon, D., Alpert, J. E., & Picard, R. W. (2020). Monitoring changes in depression severity using wearable and mobile sensors. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.584711
Riese, H., von Klipstein, L., Schoevers, R. A., van der Veen, D. C., & Servaas, M. N. (2021). Personalized ESM monitoring and feedback to support psychological treatment for depression: a pragmatic randomized controlled trial (Therap-i). BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03123-3
Thase, M. E., Wright, J. H., Eells, T. D., Barrett, M. S., Wisniewski, S. R., Balasubramani, G. K., McCrone, P., & Brown, G. K. (2018). Improving the efficiency of psychotherapy for depression: Computer-assisted versus standard CBT. The American Journal of Psychiatry, 175(3), 242–250. https://doi.org/10.1176/appi.ajp.2017.17010089
Weaver, S. J., Che, X. X., Petersen, L. A., & Hysong, S. J. (2018). Unpacking care coordination through a multiteam system lens: A conceptual framework and systematic review. Medical Care, 56(3), 247–259. https://doi.org/10.1097/MLR.0000000000000874
Your paper must include the following:
Identifying a chronic health condition listed on the CMS websiteLinks to an external site.
**** The condition I choose for this paper is : Depression
Description of the health issue chosen from the CMS website.
The incidence and prevalence of this condition in the US.
How the condition is diagnosed, monitored, and treated in individuals with this condition?
Description of the interdisciplinary team that will participate in coordinating care. Specifically, define the role of the APRN in management and coordination.
Can care teams use the CCCR model? Think in terms of systems and complexity reflective thinking. If not, name another model to help manage care?
What is the cost of managing this disease in the county you live? Download the CMS Excel to determine the cost of the condition in context to the state and county. Use the CMS link below: Spending County Level: All Beneficiaries, 2007-2018 (ZIP) Links to an external site.
What resources are available to help manage the costs of care related to this condition?
Identify barriers or challenges that you foresee for patients and care teams. How can barriers be overcome?