Optimizing Depression Outcomes in Rural Family Practice

The United States Preventive Services Task Force recommends screening for depression in clinical practices only when the practice has the means and procedure to ensure that the diagnosis can be followed with effective treatment and follow-up. The purpose of this scholarly project is to increase provider knowledge on the systems that have been shown to optimize depression outcomes by creating an educational presentation to present to family practice providers in Vernal and Roosevelt, Utah. This presentation will highlight clinical guidelines for depression screening and management and explain how these guidelines can be instituted in practice. Rural areas are particularly impacted by depression and its costs. There is a significantly higher prevalence of depression in rural areas, yet few rural providers use depression clinical guidelines in their practices. Depression is under recognized and under-managed by Primary Care Providers (PCPs) in rural areas. Several guidelines exist for depression management in Primary Care. Among these are the 2013 Institute for Clinical Systems Improvement, 16th ed., the United States Preventive Services Task Force screening guideline, and the National Collaborating Center for Mental Health 2010 guideline. However, other guidelines need to be considered when managing depression in Primary Care; these include reimbursement agencies such as Medicare/Medicaid and private insurances. Among literature that studies depression strategies, the Chronic Care Model and the Collaborative Care Model are supported by evidence to improve depression outcomes. However, even strategies with high evidence must be tailored to rural areas where some important strategy components are not available. This project includes four objectives: 1) Based on findings from a literature review, create presentation on how to institute depression screening and management in primary care. The presentation will be evaluated for Evidence Based Practices and quality of content by two Content Experts. 2) Assess community for available mental health services; organize services for handout at presentation. 3) Explore the feasibility of Utah State University-Uintah Basin Masters of Social Work program for ability to help meet needs of collaborative care between PCP and Mental Health Providers in the community. 4) Present education to PCPs in Vernal and Roosevelt , Utah. The chronic nature of depression is well supported in practice and in literature. It is not appropriate for the treatment goal of depression management to be a lessening of symptoms any more than a lower blood sugar, as opposed to a normal blood sugar is the goal of diabetes management. The goal of depression management is remission. Providers need to be educated, not only on strategies that tend to achieve remission such as pharmacology of appropriate dosing and duration, but also on what strategies they can actually implement that lead to optimal depression outcomes.