You will find new questions to screen for anxiety, depression and "coping" within the Emotional Wellbeing Section. These mental health conditions are very common in patients living with long-term conditions, and are associated with poorer health outcomes and reduced quality of life.
There are no “right or wrong” answers here. We want you to have a conversation with the patient about their feelings, and perhaps intervene if you can. Some patients may require onward referral for more specialist support.
• The risk of mental health problems increases substantially in those with long term physical conditions.
• Rates of mental health problems increase with the number of long term physical conditions and as socioeconomic deprivation worsens.
• A period of a month is a useful indicator as it shows general feelings.
COMPLETING THE TEMPLATE
Ask the 2 depression questions and the 2 anxiety questions.
• Unfortunately, at this time, there are no Read-codes available to record the results of the anxiety screening. We have applied for codes to be created, and will amend the template once these exist.
• In the meantime, EMIS users might wish to use the following EMIS codes to record the scores, if you wish:
GAD-2 (generalised anxiety disorder 2) scale score : Code EMISNQGA18
• “Depression screening using questions” has a Read Code 6896
THE COPING QUESTIONS
If your conversation with the patient makes you feel that they are not coping with their condition on an emotional level, then you can record this on the template using the code provided.
This code will carry though to the Health Determinants template, where the patient may wish to discuss their emotional wellbeing as part of their agenda setting during the next part of the consultation.
• The Health and Wellbeing Directory lists community services to support patients to manage their long term condition, including peer support services and patient education programmes
• Depression will sap a patient’s motivation so, where possible, minimise the action required on the part of the patient (eg arrange an appointment with a service rather than give the number to the patient).
• Appropriate action should be taken. If the patient is showing a bit of anxiety and/or depression, think about when you might call them back in to discuss. If patient is showing significant anxiety and/or depression, refer to GP.
• Self-efficacy (a patient’s belief in their own ability to manage their condition) is an independent predictor of survival.
• People who manage their own condition confidently and make daily decisions to improve their health and wellbeing have improved clinical, emotional and social outcomes.
• The health and wellbeing of carers should be safeguarded through the provision of the support they need to continue in their caring role.
• Community resources can support people to manage their long term condition more effectively.
• Changes to the patient’s family life and their support mechanisms may be necessary following diagnosis or deterioration.
• This section links to the health determinants section; it starts the process of helping the patient to prioritise topics for further discussion.