Patient outcomes following an intervention involving community pharmacists in the management of depression

OBJECTIVE: Documentation and evaluation of patient outcomes in a pilot study into the role of rural community pharmacists in the management of depression. DESIGN: Parallel groups design with a control and intervention group. SETTING: Thirty-two community pharmacies in rural and remote New South Wales, Australia. PARTICIPANTS: One hundred and six patient participants, mean age of 46 years, predominantly female, not currently employed, recruited by participating pharmacists. INTERVENTIONS: Intervention pharmacists were given video-conference training on the nature and management of depression by a psychiatrist, psychologist and general practitioner and asked to dispense medication with extra advice and support. Control pharmacists were asked to provide usual care. MAIN OUTCOME MEASURES: Adherence by self-report, K10, Drug Attitude Index. Results: The results indicated that adherence to medications was high in both groups (95% versus 96%) and that both groups had improved significantly in wellbeing (a reduction K10 score of 4 (control) versus 4.7 (intervention)). No significant change was found in attitude to drug treatment once baseline scores were controlled for. CONCLUSIONS: Because both groups improved in wellbeing it is not possible to claim that the training provided to the intervention pharmacists was responsible for the success. However, the improvements gained in such a short time (two months) suggest that the involvement of pharmacists has had a beneficial rather than negative effect. Further research into the most appropriate ways in which to integrate the skills of pharmacists into a model of mental health care delivery in rural communities is recommended.     

The Orange Declaration on rural and remote mental health

Rural mental health outcomes have been persistently poorer than those in larger cities suggesting that the prevailing investments to improve matters are not working. Mental health researchers and service providers from New South Wales, Victoria, Western Australia and the Australian Capital Territory met in Orange in October 2018 to explore issues pertaining to rural mental health and well‐being. The group recognised and acknowledged that rural residents experience a series of interconnected geographical, demographic, social, economic and environmental challenges which are not addressed adequately by the current mix of services. This declaration has been endorsed by those listed below and we welcome further support. We list ten interrelated problems and ten solutions. As a group, we take this declaration as an opportunity to invite discussion about how we can collectively improve the mental health of rural residents through research, service design and delivery. We invite the reader to consider endorsing this declaration. A short summary of supporting evidence is available online at https://www.crrmh.com.au/ .     

Health visitors' perceptions on their role to assess and manage postpartum depression cases in the community

The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence‐based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.     

我国农村医疗卫生体制分析

近几年来，随着农民收入的增长相对缓慢，政府对农村卫生资金投入不足，造成农村卫生人才缺乏，基础设施落后，某些地方传染病、地方病有所抬头，医疗费用居高不下，农民因病致贫、因病返贫现象突出，农村合作医疗举步艰难等等。建议：(1)继续深化卫生服务体系改革。(2)增强政府筹资的作用.     

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10‐session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty‐five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre‐ and post‐programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter‐agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co‐ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.     

Patient ethnicity and perceptions of families and friends regarding depression treatment

Objective. Black Americans are less likely than white Americans to seek professional treatment for depression. Whether treatment recommendations are sought and implemented by patients will be influenced by the role families and friends play in diagnostic acceptance and treatment decisions. We investigated the association of ethnicity with the perceived need for treatment of depression by family and friends of older primary care patients.

Design. Cross-sectional survey of 355 older adults with and without significant depressive symptoms was conducted. At the baseline visit, family and friends’ ratings of apathy and need for depression treatment were obtained on 314 of the 355 patients (88% response rate) and examined according to ethnicity. Participants were interviewed using standardized measures of chronic medical conditions, functional status, and psychological status.

Results. Older black patients compared to older white patients were less likely to be rated as needing depression treatment by their family and friends (odds ratio (OR)=0.34; 95% confidence interval (CI)=[0.18, 0.64]) adjusting for depressive symptoms, cognition, functional status, and other potentially influential characteristics.

Conclusions. Our study suggests that patient ethnicity may play a role in a family member's or friend's perceived need for depression treatment of older adults who present in the primary care setting. Further study of attitudes, expectations, and values of patients and family members or friends in primary care settings may help elucidate the interplay of physician, patient, and family member or friend.     

Mental health issues and resources in rural and regional communities: an exploration of perceptions of service providers

OBJECTIVE: To identify service providers' and community organisations' perceptions of the resources available to support people with mental illness and the unmet needs of this client group in rural Queensland. DESIGN: An exploratory study was undertaken involving focus group interviews across the study sites. SETTING: Five regional towns in rural Queensland. PARTICIPANTS: Ten to 14 members were recruited for each of the five focus groups. The groups represented a diverse mix of participants including health and community service providers and representatives from community organisations. Results: Participants identified gaps in services in relation to health, employment and education, housing and accommodation, transport and social inclusion and health promotion. Inter-service communication and inappropriate funding models were themes affecting service delivery. CONCLUSIONS: Specific service issues of housing and transport were identified to be particularly problematic for people with mental illness across all towns. Intersectoral communication and funding models require further research.     

Rural pathology under the microscope

There is little discussion about the crisis in the pathology and medical science workforce despite the implications it has for the whole health system. The crisis has greater implications for rural and remote locations because of the range of skills and multidisciplinary approach required in these areas. Recognition of the clinical significance and organisational importance of the sector is required as is recognition of the unique characteristics of rural and remote pathology and greater support for rural and remote pathology practitioners.     

Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan,Canada

Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.     

Depression and remoteness from health services in South Australia

OBJECTIVE: To determine whether the prevalence of depression, its associated quality of life, treatment and mental health literacy about depression varied according to accessibility to health services. DESIGN: Face-to-face interviews with a random and representative sample of the South Australian population (aged >or= 15 years) were conducted between March and June 2004, with the respondents stratified using the Accessibility and Remoteness Index of Australia into categories of 'highly accessible', 'accessible', and 'moderately accessible and remote'. RESULTS: From 4700 households selected, 3015 participants were interviewed (65.9% response rate). The prevalence of major depression and other depressions was not significantly different between each of the categories, although there was a trend for those from moderately accessible and remote areas to be less depressed overall. A significantly lower proportion of respondents from moderately accessible and remote locations reported that they had family or close friends who had suffered from symptoms consistent with depression, or that they had ever had treatment for those symptoms. However, there was no significant difference between the groups in those who had ever had or who were currently taking antidepressant medication. For those who were depressed, a significantly higher proportion from the accessible, and moderately accessible and remote regions had seen a community or district health service, social worker or other counsellor as compared with those from the highly accessible area. CONCLUSIONS: These findings indicate that depression is no more prevalent in less accessible regions of South Australia, and that when it is present, its treatment, in terms of antidepressants, which can be considered as a proxy marker for the overall management of depression, is similar to treatment in more accessible areas.     

headspace: National Youth Mental Health Foundation: making headway with rural young people and their mental health

Mental health is the number one health issue affecting young people in Australia today, yet only one in four of these young people receive professional help. Approximately 14% of 12- to 17-year-olds and 27% of 18- to 25-year-olds experience mental health problems each year. However, many do not have ready access to treatment or are reluctant to seek that help. These issues might be exacerbated in the rural and remote regions of Australia where sociocultural barriers such as stigma, lack of anonymity and logistic difficulties including cost and availability of transport can hinder young people accessing mental health services. headspace: the National Youth Mental Health Foundation has been funded to address these issues. headspace will provide funding for the establishment of communities of youth services across Australia, provide national and local community awareness campaigns and plans, establish a centre of excellence that will identify and disseminate evidence-based practice in addressing youth mental health issues, and translate findings into education and training programs that are targeted at service providers to work with youth mental health. The communities of youth services will build the capacity of local communities to identify early, and provide effective responses to, young people aged 12-25 years with mental health and related substance use disorders. Specific approaches in rural, regional and remote areas will be developed as well as specific programs to involve young Indigenous people.     

The self-reported health condition of women after their participation in a stress management programme: a pilot study

From a public health perspective, it is important to develop effective measures to deal with stress which are based on the individual's participation, such as stress management provided in group sessions. Therefore, the aim of the present study was to compare and evaluate the self-reported health condition of women in terms of their general symptoms, stress and sense of coherence (SOC) after participation in a stress management programme. The intervention, which had a modified crossover design and involved 40 women divided into two groups (G1 and G2), comprised eight meetings, the content of which was both theoretical and practical, and included information about stress, stress management, massage and mental training. A questionnaire was filled in on three occasions: before and after the intervention (8 weeks later), and after another 8 weeks (16 weeks later). The questionnaire contained 60 items comprising background factors, general symptoms, stress and SOC. No significant differences existed between the groups at baseline. In favour of the intervention, significant differences were found between the groups with regard to fewer general symptoms (P = 0.035) as well as a tendency to stress reduction (P = 0.060). A comparison within groups showed that both groups had a significant reduction in symptoms after the intervention (G1, P = 0.002; and G2, P = 0.003) and in reduced stress (both P = 0.001). After a further 8 weeks, both groups still showed significantly fewer general symptoms and reduced stress, as well as significant improvements with regard to SOC (G1, P = 0.012; and G2, P = 0.026). These findings indicate that the combination of mental training and massage in this stress management programme had a positive influence on the women's health condition. The pilot study design could be used in a full-scale study with randomised groups.