Research projects

A pragmatic trial of a “stepped care” intervention for people with depression and cardiac failure

Principal Researchers

Associate Professor David Clarke a, Professor Barry McGratha, Dr Donita Bairdb, Professor James Dunbar c, Professor Prasuna Reddyc, Mr Gavin Dysond

Institution

a Monash University and Southern Health

b Southern Health

c Greater Green Triangle University Department of Rural Health (Flinders and Deakin Universities)

d Monash University

Funding

$100,000

Award Type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

Depression is common in people with chronic heart disease and is associated with poorer outcomes.  Chronic disease combined with depression and/or social isolation requires complex interdisciplinary management systems involving primary, secondary and tertiary level care.  It is very uncommon for treatment of depression to be well-integrated with the management of chronic disease.

This project involved the development of a three-step care program to combine cardiac failure management with best-practice treatment for depression.  The first step involved a four-week education process facilitated by a heart failure clinical nurse specialist.  A manual, developed using the expertise of consumers, clinicians, researchers and other stakeholders, provided information about and self-management strategies for living with heart failure.  After completing the manual, patients were screened for depression.  In the second step, patients identified as having depression were referred to their GP for treatment.  These patients were re-screened for depression following a period of primary care treatment.  In the final step, those who were still experiencing depression received treatment (interpersonal psychotherapy) from a clinical psychologist.

The project assessed the feasibility and effectiveness of this stepped care model for patients with heart failure.

Key findings

Interpersonal psychotherapy was well received by heart failure patients.  This was demonstrated by a low drop-out rate and good levels of participation.  No significant modifications to the generalised interpersonal psychotherapy approach were needed.  Referring agents expressed interest in the interpersonal psychotherapy approach and appreciated having access to a choice of two evidence-based treatments for their clients.

Development of the four-week education process and support manual involved consultation with clinicians, researchers, diverse organisations and consumers to ensure content was both clinically correct and appropriate for the audience. 

Implications for policy, practice and further research

Complex care programs that cover both disease management and depression can be developed and implemented in the public sector but take time, careful thought and collaboration between a range of stakeholders.  Interpersonal therapy is well received, but more therapists need access to training and supervision.  The next step is to extend use and evaluation of the manual to other heart failure programs around Australia and seek feedback to further develop the program.  A randomised controlled study would more robustly demonstrate the effectiveness of the program.

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