Navigation

Shared learning database

Type and Title of Submission


Title:

Depression and Anxiety Spectrum Disorder Care Pathway

Description:

This web-based "Care Pathway" has been developed as a partnership project between Surrey PCT and Surrey and Borders partnership Foundation NHS Trust. This "Pathway" provides a mechanism for improving outcomes for depression and anxiety spectrum disorders (GAD, PD, PTSD, OCD and social phobia) - especially disability - through more appropriate choices of management. Importantly it is also a tool that will be useful to patients and carers and for education and training of healthcare professionals.

Category:

2010-11 Shared Learning examples

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG90,22,133,31,26 - Depression with a Chronic Physical Heath Problem, Generalised disorder and panic disorder ; Obsessive compulsive disorder and body dismorphic disorder, Post-traumatic stress disorder (PTSD):

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

The main aims of this project were to develop a web-based care pathway that would: - Improve recognition and management of common mental illness (depression and anxiety spectrum disorders (general anxiety, panic, social phobia, post traumatic stress and obsessive compulsive disorders) consistent with NICE and other relevant national and international guidelines. - Improve the care pathway so that people got the right care by the right people at the right time. - Be readily accessible on the world wide web for professionals, patients and carers. - Have utility for education and training of healthcare professionals. - Be a comprehensive resource for medical and non-medical treatment and special circumstances such as in pregnancy. - To raise the profile of depression and anxiety as a disease. - To improve the understanding of the relationship between chronic physical illness and common mental health problems. - Improving treatment decisions. - Improve patient outcomes. - Improve the clinician's use of monitoring tools. This pathway is available on the World Wide Web, and is a useful tool that was developed by primary and secondary care healthcare professionals for use in both areas. This pathway will aid clinicians meet QoF targets and NICE quality standards.

Objectives

- Improve recognition and diagnosis. - Educate about appropriate treatment choices and management of lack of efficacy and/or tolerability. - Improve the overall management to remission of symptoms and restoration of normal function. - Improve the appropriateness of referrals to secondary care.

Context

Studies have confirmed that there are not only major problems of recognition and appropriate management of common mental illness in primary care but also failure to appreciate: - the importance of physical and psychological co co-morbidity and how they can compromise recognition and accurate diagnosis. - that depression will become the second highest cause of disability by 2020 (WHO). As well bringing guidelines together the main aims of this project were to develop a web-based care pathway that would: - Improve recognition and management of common mental illness (depression and anxiety spectrum disorders (general anxiety, panic, social phobia, post traumatic stress and obsessive compulsive. disorders) consistent with NICE and other relevant national and international guidelines. - Be readily accessible on the world wide web for professionals, patients and carers. - Have utility for education and training of healthcare professionals. - Be a comprehensive resource for medical and non-medical treatment and special circumstances such as in pregnancy. - To raise the profile of depression and anxiety as a disease. - To improve the understanding of the relationship between chronic physical illness and common mental health problems. - Improving treatment decisions. - Improve patient outcomes. - Improve the clinician's use of monitoring tools. This pathway is available on the World Wide Web, and is a useful tool that was developed by primary and secondary care healthcare professionals for use in both areas. This pathway will aid clinicians meet QoF targets and NICE quality standards.

Methods

The team consisted of four people - two primary care pharmacists, GP with special interest in mental health, and chief pharmacist for the mental health trust. We met on weekly basis to discuss the pathway and agree actions to take away and to complete. We reviewed evidence, guidelines and text books. Website pages were initially developed as word documents, and due to our commitment to other duties took year or so to develop. We had involved our IT department initially and they had stated they would be able to help us develop the website. When our word documents were ready to be converted to web pages we approached our IT department who asked us to develop the pages on the intranet rather than the internet. We were disappointed as this would not meet our criteria, nevertheless we decided to proceed thinking we can convert it later. We met many challenges developing it on the intranet and had little support from the IT department. We had built up excellent relationships with Servier Laboratories, and in a corridor conversation we happened to mention our difficulties. Servier kindly offered to help put the pages on the internet as we had always wanted. This took a further three months. In the meantime NICE had issued new Depression guidelines, so some pages of the pathway were updated and amended . (NICE recently published new anxiety guidelines and these will be incorporated in the near future). At about every six months we discussed and showed our developments to our stakeholders. We took aboard any of their ideas or concerns and incorporated them into the pathway. For example the 'Quick Links' and Stopping and Swapping table was part of the idea of the Medicines Management Committee The project did not occur any additional costs, except for our time and efforts. It has been a thoroughly enjoyable project with a dedicated and enthusiastic team. It has been a learning experience

Results and evaluation

We launched the website with three educational events across Surrey. Each event was attended by a mixture of primary and secondary staff ranging from pharmacists (community, primary, secondary), GPs, nurses, consultants, prison staff. GP practices that had chosen to attend the event as it was one of the prescribing QoF choices had to produce an action plan after the event on how they would manage their patients with depression and anxiety. These will be submitted in April 2011. For 2011/2012 we will be undertaking further education and auditing change in practice. The educational events provided an excellent interface forum for clinicians in primary and secondary care build new and foster existing relationships.

Key learning points

The one main key learning point is to have dedicated support from a web developer. Ideally it would be best to have an expert. Try to obtain funding or sponsorship for this. It took a long time to develop as this was not part of our main job. In future a dedicated team to work on the development would be a much faster and efficient way of completing this task. Be prepared for new guidelines and evidence being issued whilst developing such a pathway, and be able to respond and change the pathway if necessary. IAPT was also starting up at the same time as we launched our event, and IAPT were present at our launch. This was very useful.

View the supporting material

Contact Details

Name:Dr Jill Rasmussen
Job Title:GPSi Mental Health
Organisation:NHS Surrey
Address:c/o Arlington Cottage
Town:Spook Hill, North Holmwood
County:Surrey
Postcode:RH5 4HH
Phone:01306 883272
Email:jill.rasmussen@virgin.net

 

NICE handles personal information provided to the Institute in accordance with the Data Protection Act 1998. Find further details in our data protection policy.

This page was last updated: 11 February 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.