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SUPERVISING PSYCHIATRIST MANUAL Download Manual
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Cover | Preface | Contents | Overview | Care Manager Role | Clinician Communications


OVERVIEW OF THE DEPRESSION CARE PROCESS


The process of care for detecting and managing depressive disorders in primary care can be divided into steps. These steps are listed below. The first three steps are completed by the primary care clinician and are discussed in detail in the Clinician Education Manual. Steps four through six are conducted by the primary care clinician with assistance from the care manager both of whom are supported by the psychiatrist. These steps are discussed in more detail in the Clinician Education Manual and the Care Manager Training Manual. The aspects most relevant to the consulting psychiatrist are described in the following pages.

The steps involving the psychiatrist are underlined and in italics.

1.   RECOGNITION AND DIAGNOSIS
   •   “Flags” for depression
   •   Two question screen
   •   PHQ-9 for depression diagnosis/severity
   •   Suicide risk
   •   Other pertinent diagnostic assessments
   •   Formulate and explain diagnosis

2.   TREATMENT SELECTION
   •   Additional history including previous treatment, co-morbidity
   •   Explain treatment options
   •   Elicit patient treatment preferences

3.   INITIAL ACUTE PHASE TREATMENT
   •   Patient engagement
   •   Provide key educational messages
   •   Set self-management goals
   •   Explain and recommend care management

4.   CARE MANAGEMENT PROCESS
   •   Initial call(s) to monitor treatment initiation / adherence
   •   Mail written educational materials (Unless PCC has provided)
   •   Follow-up calls using PHQ-9 to assess treatment response
   •   Care management supervision with psychiatrist
   •   Communication with clinician

5.   ACUTE PHASE FOLLOW-UP
   •   Care management contacts coordinated with PCC office visits
   •   Evaluate patient response to treatment with a goal of remission
   •   Modifying treatment when sub-optimal response
   •   Strive for remission

6.   CONTINUATION & MAINTENANCE PHASE CARE
   •   Continue treatment response monitoring after remission
   •   Administer maintenance dysthymia questionnaire
   •   Discuss risk factors / need for long-term prophylactic treatment during care management supervision
   •   Continue counseling and/or antidepressant treatment for 4-9 months to prevent relapse
   •   Continue long-term prophylactic treatment and monitoring for at risk patients



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