title: Improving community-based services for older patients with depression: the benefits of an educational and service initiative.
abstract: OBJECTIVE
  The objective of this study was to report a quality improvement project for older patients with depression. The initiative focused on both clinical practice changes (improvement of medical, neurocognitive and behavioural assessment) and service development (greater continuity of care).
  
  
  METHODS
  After initial identification of key deficits, implementation of a service and educational initiative took place within a district mental health service. The service consisted of an inpatient unit, a specialized psychogeriatric service and two adult community mental health services. Mental health staff received education regarding the specific needs of older patients with depression and were provided with assessment materials, patient education and treatment aids. General practitioners participated in shared long-term management.
  
  
  RESULTS
  Following graded implementation, the management of 44 subjects (mean age = 65.4 years, 91% female) recruited over an 8-month period was reviewed. Compared with 99 subjects (mean age = 68.9 years, 69% female) from the earlier 12-month assessment phase, there were significant improvements in medical (43% to 92%), neurocognitive (37% to 84%) and behavioural (e.g. suicidal ideation: 78% to 100%) assessments. Similarly, relevant laboratory investigations (neuroimaging: 21% to 67%) and communication with general practitioners (73% to 97%) improved. The most change occurred in the adult community-based treatment services.
  
  
  CONCLUSIONS
  A coordinated management and educational initiative resulted in marked improvement in basic medical and psychiatric assessment and more integrated care. These changes did not require expansion of specialist services.
authors.affiliation: Division of Psychiatry and Mental Health, St George Hospital and Community Health Service, Kogarah, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Mutch
authors.forename: M
authors.initials: M
authors.lastname: Tobin
authors.forename: I
authors.initials: I
authors.lastname: Hickie
authors.forename: T
authors.initials: T
authors.lastname: Davenport
authors.forename: D
authors.initials: D
authors.lastname: Burke
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000517:prevention & control; D003156:Community Mental Health Services / Q000592:standards*; D019033:Delivery of Health Care, Integrated; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D015577:Geriatric Assessment; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D008297:Male