DOMAIN | Primary Care Recommendations for an Adapted mhGAP-IG.v2 |
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Rank ordered by mean score | Based on all items receiving consensus after two waves of Delphi survey (Wave 1: 75 CHC doctors; Wave 2: 59 CHC doctors) |
Developing a patient-centered guide | 1.1 Not just patient-centred but person-centred Ensure patient privacy Sensitive to events in patients life (i.e. grief) Accommodate for patient diversity 1.2 Provide a personalised patient management plan (PMP) developed in partnership with the patient flexible to evolve over time to suit patient needs outlines several strategies to elicit positive behaviour change 1.3 PMP to incorporate doctor, patient and administrative outcomes:- Doctor review of treatment progress (e.g. drug side effects, treatment changes) patient’s treatment evaluation (e.g. treatment experience and engagement with therapy) administrative tracker (e.g. consultation appointments and potential referral options) 1.4 Doctor with mental health certification to develop PMP template 1.5Address contextual differences Consider suicide risk as a priority Highlight family involvement in every stage of care Provide specific examples of patient success stories from Shenzhen |
Depressive episodes in bipolar disorder | 2.1 Differentiate between treatment practice for (uncomplicated) depression and depressive episode in bipolar disorder mood stabilizer required as an adjunct to antidepressant treatment 2.2 Check for symptoms of mania with the patient or with family members |
Communicating depression to patients and the community | 3.1 Doctors to play a role in improving community awareness and health literacy 3.2 Stronger emphasis of the role of family in patient support 3.3 Include strategies for CHC to monitor patients at risk of suicide 3.4 Expand content of patient psychoeducation include approaches to develop patient trust (e.g. listening with empathy) address any misconceptions about the disease provide treatment success stories prepare patients for community stigma discuss the importance of treatment adherence provide advice on engagement with activities encourage attendance of follow-up appointments with CHC/specialists agree to a management/healthcare plan provide advice on self-care Consider implementing an appointment system |
Healthcare interconnectivity | 4.1 Highlight community involvement with monitoring patients at risk of suicide 4.2 Clarify referral pathways and the division of professional responsibilities 4.3 Highlight opportunities for medical and non-medical intersectorial care* 4.4 Reference involvement of family as a component of intersectorial care 4.5 Include a reminder to keep the patient central to all discussions |
Access/usage to depression questionnaires | 5.1 Recommend questionnaire usage during management and/or/both follow-up 5.2 Questionnaires conducted in a private consultation room 5.3 Doctors & nurses can administer questionnaire (assuming training provided) 5.4 Clarify scope for tools (i.e. multiple times? non-clinic settings?) |
Managing patient information | 6.1 Review a patient’s history before consultation and update patient records 6.2 Supplement information from patient management system if necessary 6.3 Validate patients’ treatment with specialists, other treating doctors, family members or by sighting medication 6.4 Hold regular in-clinic meetings to discuss difficult cases with other doctors |
Considering pharmacological interventions for depression | 7.1 Address Dr’s role with regards to monitoring and changing drug dose 7.2 Include indication and side effect profiles for each drug group 7.3 Include drug availability & reimbursement status for each drug group 7.4 Include adherence advice for each drug group 7.5 Provide details of latest generation of drugs 7.6 Provide Chinese brand names 7.7 Add information for Benzodiazepines |
Symptom presentation of depression | 8.1 Guide should “reflect a real-life consultation” consider whether a patient had had a previous episode of depression ascertain details of relationship problems (including grief) assess patient’s risk of suicide early in consultation consider physical symptoms first 8.2 Include triggers and risk factors for depression 8.3 Diagnosis based on “a symptom spectrum rather than core symptoms alone” merge both the core and additional symptoms into one listing include loss of libido in symptom listing order the list by good predictors of depression/commonly seen symptoms provide additional details of symptom profile changes over time 8.4 Structural clarity to differentiate between physical and mental symptoms 8.5 Additional symptom information required for children 8.6 Careful quantifications/translations required for “sleeping too much” “talking and moving more slowly than usual” |
Overall structure | 9.1 Some or major restructuring needed to better reflect the context of use 9.2 Emphasise intersectorial involvement including family/community network 9.3 Highlight differences between depression and a depressive episode in bipolar disorder 9.4 Integrate follow-up and management into one continuous section 9.5 Commence assessment with consideration of patients at high risk of suicide 9.6 Place the patient at the centre of the guide |
Follow-up | 10.1 Define follow-up and explain why it is necessary to determine a patient’s treatment status to establish previous therapy/treatments received to monitor current treatment side effects & assess for improvement 10.2 Explain how to assess for improvement:- i.e. itemise signs of improvement 10.3 Highlight key CHC outcomes to be achieved from follow-up consultation options for basic psychotherapy at CHC level referral options for either psychological interventions/drug treatment 10.4 Itemise modes of follow-up contact (face-to-face, telephone, electronic) 10.5 Recommend preferred mode of consultation contact ideally, face-to-face follow-up for all patients at least, face-to-face for all those with serious conditions patient’s preference for non-emergency cases 10.6 Frequency and duration of contact determined by depression severity, risk of self harm and treatment compliance |