title: Clinical outcomes associated with screening and referral for depression in an acute cardiac ward.
abstract: OBJECTIVE
  The aim of this paper is to describe the implementation of a depression screening and referral tool in two cardiac wards of a major metropolitan public hospital. The tool consisted of two sections: (1) screening for depression risk (Cardiac Depression Scale-5) and (2) consequential referral actions.
  
  
  BACKGROUND
  Prior research has shown that depression in patients with heart disease is associated with significantly impaired quality of life, decreased medication adherence, increased morbidity and increased use of healthcare services.
  
  
  METHODS
  A prospective in-patient study design.
  
  
  METHODS
  A consecutive sample of 202 patients admitted to either the cardiac medical (n = 145) or surgical (n = 57) wards of a major Melbourne metropolitan hospital were recruited into the study over an 18-week period.
  
  
  RESULTS
  Just over half (54%) of the patients were identified as 'at risk' of depression. Of these, 19% were assessed as moderate risk and 35% high risk. Of those patients, 91% had the risk score documented in their medical history, 90% had engaged in discussions with clinicians regarding their risk score, 85% had their risk score communicated formally to the medical team and 25% were formally referred for appropriate follow-up - significantly more than prior to implementation of the screening and referral tool.
  
  
  CONCLUSIONS
  By providing a formalised mechanism for detecting depression, documented screening and referral rates improved for those with comorbid depression and heart disease affording an opportunity for early intervention. These findings support a move towards integrated approaches to screening of depression to become standard practice in the acute cardiac setting.
  
  
  CONCLUSIONS
  Such mechanisms also have the potential to initiate the development of new models of care that acknowledge the complexity of comorbid depression and heart disease and provide pathways from speciality to primary care which integrate the physical and psychosocial domains inclusive of screening, referral, systematic monitoring and streamlined behavioural and physical care.
authors.affiliation: Cardiovascular Research Centre, Australian Catholic University, Melbourne, Vic., Australia. chantal.ski@acu.edu.au
authors.forename: Chantal F
authors.initials: CF
authors.lastname: Ski
authors.forename: Karen
authors.initials: K
authors.lastname: Page
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cummins
authors.forename: Mike
authors.initials: M
authors.lastname: Salzberg
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D014739:Victoria