Dear Enric,

I am currently reviewing the literature on collaborative care for depression. I stumbled upon the work of Huijbregts, in the Netherlands, which you may get interested in:

Huijbregts, K. M. L., de Jong, F. J., van Marwijk, H. W. J., Beekman, A. T. F., Adèr, H. J., Hakkaart-van Roijen, L., et al. (2012). A target-driven collaborative care model for Major Depressive Disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative. Journal of Affective Disorders, 146, 328-337. doi: 10.1016/j.jad.2012.09.015.

Huijbregts, K. L. M., de Jong, F. J., van Marwijk, H. W. J., Beekman, A. T. F., Adèr, H. J., & van der Feltz-Cornelis, C. M. (2013). A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions. Journal of Psychosomtic Research, 74, 179-185. doi: 10.1016/j.psychores.2013.01.004.

IJff, M. A., Huijbregts, K. M. L., van Marwijk, H. W. J., Beekman, A. T. F., Hakkaart-van Roijen, L., Rutten, F. F., et al. (2007). Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; A randomized clinical trial. BMC Health Services Research, 7:34. doi: 10.1186/1472-6963-7-34.

We are thinking about ways to improve (1) guideline adherence, and (2) the collaboration between primary and secondary care, and we also had some crazy ideas about e-tools that could add to both. Perhaps we could work together?

Kind regards,

Kris

Yes, my colleague prof. Christina van der Feltz and I and several others worked on this with a software company in the Netherlands, Oba Milestones software. A tracking system for depression was developed that seemed to work well. To link it to care systems is complicated, however.

Another option would be to use the Four Dimensional Symptoms Questionnaire, that seems better geared towards primary care. Happy to discuss this!  

BW Harm 

Dr Richard Tranter, Clinical Senior Lecturer at University of Otago, New Zealand is working in this area. He is currently working in Nelson, New Zealand.

Interesting, is he in on this discussion somehow? Harm

I can't find him on Researchgate, but I recently heard him talk on this subject. A quick Google and it shouldn't be hard to track him down with the above information. He used to work at Bangor University, North Wales.

www.en.hooshdar.com

Online Medicare is a method in which parts of a medical process — whether it’s diagnosing, monitoring or the treatment itself — will be done using online services. Basically, whatever you can trust a computer with, will be done by computers.

Dr. Hooshdar’s Online Medicare, is an effort to bring fairness in health to people across the globe using modern methods.

What has been done so far

Dividing the project into phases, we chose psychiatric disorders, depression and anxiety to be our focus in the phase one — since parts of the medical process for these disorders could be done safely using today’s technology in the online method.

We researched highly prevalent medical diseases that could cause psychiatric problems, and we came up with the list below for diseases that we focus on during the phase one:

Diabetes

Impaired GTT

Hypocalcemia

Hypoglycemia

Hypo-and-Hyperthyroidism

Megaloblastic Anemia

Hyperlipidemia

All these diseases are highly prevalent in our first target country — Iran — and they all are likely to cause psychiatric disorders such as depression and anxiety.

How does it work?

We developed a web application and created a website in which users can register in and use its diagnostic and treatment features. It basically allows patients to determine the severity of their psychiatric disorder using international conventions, see if biologic diseases could have affected their psychological wellness, get basic advice on what to do with their problem — Be it a referral to a specialist, advice on a change in lifestyle and eating habits, diets, safe drug prescriptions, etc. — and also provide their physician with up-to-date information about their condition and treatment advice using the latest researches in the field.

The process happens in a few arguably simple steps that we have tried to make as easy and yet accurate and helpful as possible:

Step 1 – We collect some basic medical specifications about the patient such as age, sex, relationship status, etc.

 Step 2 – The patient decides whether to have an anonymous profile in the system or an official one with their name and contact info on it.

Step 3 – We offer the patient a Clinical Interview form, which they can decide to fill or skip over. The form consists of some basic information that the patient’s physician has to know in order to get a clear picture on the patient’s condition. We have tried to make this form as comprehensive as possible.

Step 4 – We provide the patient with the Beck Anxiety Inventory test and the Beck Depression Inventory test. This step can also be skipped over. The result of these tests will be provided to the patient’s physician, and also, they will be used by the system to assess the patient’s mental condition.

Step 5 – We prepare a profile sheet for the patient. Whatever we have gathered about them so far will be put in the profile sheet and it can help the patient’s physician make more informed decisions about the treatment plan. It will also say that if psychological counseling will suffice in treating the disorder or more active approaches should be taken. This sheet does not have legal value.

Step 6 – We provide the patient with a lab test prescription and ask them to take it and put the results back into the system. Once the results are given to the system, it processes them using up-to-date formulas, checks them against common patterns found in patients with psychiatric disorders, and generates a report page. The report page may contain any of the following:- A green marked message if no known problem was found in the lab test results.

- Information about their problem, what could have caused it, and what should be done about it, etc.

- An urgent or a normal referral to a specialist.

- A safe drug prescription which should only be administered by the patient’s physician.

- Recommendations of change in lifestyle. Eating and sleeping habits, etc.

- The system will also generate recommendations for the patient’s physician, including advanced details of the patient’s medical conditions and what treatment methods could help the patient get better and what approaches would better be avoided.

Kris, Harm,

Thank you for your responses. I'm aware of your interesting work about depression management in the Netherlands, which is in a similar line with our work in Catalonia, in concept, aims and procedures. We'll be happy if any chance of working together arises in the future.

non. I interest to health education and promotion.