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Before discharge, the following should be in place and reviewed with the individual with depression:

  • An appointment with the psychiatrist within one week of discharge, especially if antidepressants are ordered.

  • Appointment with a psychotherapist within one week of discharge; ensure that transportation is available.

  • Substance abuse treatment if appropriate.

  • Appointment with the PCP.

  • Referrals to community resources should be made if there are any issues with living arrangements or other social concerns.

  • Support/caregiver should be given information on how and where to access support groups.

  • Medications ordered at discharge.

  • Reconciliation of medications to include antidepressants and those for medical conditions.

The individual may have numerous providers involved in his/her care; remember, depression often accompanies physical illnesses. Examples of other providers can include the following:

  • Specialists such as a cardiologist, endocrinologist, or orthopedist

  • Pharmacist

  • Physical, occupational, or speech therapists

When numerous providers are involved in the care, it is important for the individual with depression and support/caregiver to understand whom to call with clinical symptoms. Both people need to be clear about who the primary contact is and whether that person is responsible for coordinating care.

Evaluation and Outcomes

A review of controlled therapeutic studies suggests a dropout rate of up to 33% irrespective of drug class.84 If interventions of care managers with tools that can address non-adherence are utilized, perhaps this number could be decreased considerably. In addition, cost reduction of hospitalization, excessive outpatient visits, and constant changing of medications due to the absence of improvement would be dramatic. Care management intervention regarding non-adherence to medications would also assist prescribing healthcare providers to understand if the absence of improvement is due to the medication being ineffective or the non-adherence of the individual.

Key clinical markers that may demonstrate remission and a positive outcome, as indicated from the individual’s actions and care management support, are measured through an individual patient evaluation. Sleep, energy, concentration, and self-management or a sense of control may be clinical markers. Resolution

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