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Identifying and Meeting the Psychological Needs of Dialysis Patients: Implementing Screening Using the Integrating Mental and Physical Health Care in Research, Training and Services Package
Carroll, A1., Game, D1., Gökmen, R1., Beleno-Harriott, A1., Desendario, E1., Andre, T1., Tibbles, R1., Mundle, D1., Matcham, F2., Taylor, J2. & Simpson, A2
1Guy’s & St Thomas’ NHS Foundation Trust, 2Kings College London
Background:Integrating physical and mental health care is a key national priority in the UK. IMPARTS (Integrating Mental and Physical Health Care in Research Training and Services) is a package developed to enable the electronic collection of patient reported data to facilitate this process.Existing research has identified that depression and anxiety are common amongst dialysis patients, and psychological distress is associated with increased mortality and co-morbidity. IMPARTS has been integrated into routine clinical practice in a satellite dialysis centre delivering haemodialysis to 160 adults. This has allowed the multidisciplinary team to identify and respond effectively to the psychological needs of this patient group.
Methods:Screening took place in designated fortnightly blocks and was repeated once every six months. All patients proficient in the English language were invited to participate.Patients were screened by nursing staff, and supportand training was provided by the clinical psychologists embedded in the renal serviceand the IMPARTS team. Patients completed the measures (using electronic tablets) whilst receiving dialysis. Measures included depression (Patient Health Questionnaire; PHQ-9) and anxiety (Generalised Anxiety Disorder Questionnaire; GAD-7). The results were automatically uploaded in ‘real-time’ to the Electronic Patient Record. Within a dialysis appointmentthe team were able to screen a patient, review and discuss the results, and make any necessary onward referrals.
Results:Between 01st July 2013 and 16thJanuary 2015 a total of162 screening encounters have taken place.During the most recent screening blockin October 2014,61%(87/142) ofpatients participated. The prevalence of depression and anxietyis shown in table one:
Table One: Depression and Anxiety (October 2014 screening block)
n (%)Depression: / No symptoms / 67 (77)
Some Symptoms / 17 (19.6)
Probable Major depression / 3 (3.4)
Anxiety: / No symptoms / 75 (86.2)
Mild anxiety / 5 (5.8)
Probable GAD / 7 (8)
Patients with mood difficulties or significant worry were offered follow up with the clinical psychology teamforfurther assessment and management. Onward referrals were also made to liaison psychiatry and community mental health services.Some practical obstacles were identified. This included a significant number of patients whorequired assistance to use the electronic tablets, a lack of privacy on the dialysis unit and issues with wifi connectivity. In general, patients reported that screening was a positive experience.
Discussion:IMPARTS has been well established in a satellite dialysis centre. The use of the package supports a holistic approach to care for dialysis patients. Screening has identified significant psychological morbidity, and the data have been used to identify patients who might benefit from increased psychological support. Practicalissues are being considered collaboratively between IMPARTS and the clinical team;in general screening appears acceptable to patients and has been embraced by clinicians. We are currently in the process of introducing IMPARTS to a second satellite dialysis centre.