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Practice nurse-led care 'improves depression'

Regular appointments with practice nurses can improve the social functioning and severity of disease in patients with depression, finds a UK trial in over 40 GP surgeries.

The study - carried out by researchers at University College London on behalf of mental health charity Mind and published by Mind and the Royal College of Nursing - found that patients with long-term depression benefited from regular sessions with practice nurses where they could discuss treatment options and contributory factors to depression.

The three-year trial in 42 GP surgeries offered 10 appointments with practice nurses over two years to patients with depression, in a model that nursing leaders and mental health campaigners are calling on GP practices to offer to all patients with chronic depression. 

After the 10 sessions with a practice nurse, there was a average improvement in the Beck Depression Inventory of -3.7, which was statistically significant. Patients receiving the intervention also reported improved confidence, self-esteem and social functioning. There was a -0.33 improvement in the Work and Social Adjustment Scale in patients taking part in the trial, compared with baseline.

Practice nurses participating in the study, also said they felt more confident in treating depression after receiving training as part of the study. However, researchers found no significant difference in terms of the number of GP visits patients made with or without the intervention, and they reported mixed evidence of its cost-effectiveness.

In light of the findings, the authors recommend that all GP practices should offer proactive care to patients with depression, either via a practice nurse or a GP with specialist interest in mental health. It also calls on the RCGP to improve training for GPs in discussing depression, after patients in the study reported difficulties in talking to their doctors about issues other than medication.

Dr Amrit Takhar, a GP in Peterborough who took part in the trial, told Pulse: ‘Our patients and practice nurse benefited from this trial.'

‘We are looking at fully introducing this ongoing care for certain patients with depression. Often GPs see patients with depression for months and months, or years, and skilling up practice nurses to provide ongoing care can provide extra support to patients to manage the condition, help them discuss different treatments as well as related issues like lifestyle.'

‘We have shared care for conditions like diabetes and I can't see why, for some patients with chronic cases of depression, this approach can have benefits.'

Nursing leaders and mental health charities backed the impact of the intervention. Dr Peter Carter, chief executive of the Royal College of Nursing, said:‘General practice nurses play a huge role in managing the care of patients with long-term physical conditions.'

‘However, their potential for improving the quality of life for patients has never been realised across the board.'

Paul Farmer, chief executive of Mind, said the trial net the need for ongoing holistic care for people with depression.

‘Practice nurses are already offering enhanced care packages to patients for physical conditions and with the right training and support could be equipped to do the same for depression. There must be a parity of esteem in how mental and physical health problems are addressed in primary care.'

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