Table 3 Practice nurse and patient roles per step in the Step-Dep program
Step | Role of practice nurse | Role of patient |
|---|---|---|
1. Watchful waiting | Introductory consultation with patient. Explains stepped-care program and its rationale. If applicable, gives information and/or brochure about mild depression with simple advices on how to cope with mild depressive symptoms. Is available for patient, if needed | Gets acquainted with practice nurse. Receives information on stepped-care program and its rationale. Contacts practice nurse if needed |
2. Guided self-help | Explains self-help course, hands out materials. Contacts patient every other week by phone to monitor progress. Uses motivational interviewing techniques to activate the patient, if needed. If needed, invites patient to discuss current depressive symptoms; if needed offers early progress to step 3 | Starts self-help and works through course at own convenience. Discusses progress every other week. If needed, visits practice nurse and starts step 3 |
3. Problem Solving Treatment | Offers brief cognitive behavioral intervention focusing on practical skill building in 7 sessions. Explains stages of problem solving and applies to problems encountered in daily life, helping to regain control of life | Visits practice nurse for 7 PST sessions, working through problems together, learning practical skill building |
4. Referral to GP | Refers patients to GP for further assessment of depressive symptoms. Provides a summary of the offered treatment | Visits GP to discuss provided treatment and following treatment for depressive symptoms |