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Depression is the common health condition which affects the feelings, thoughts, physical health and behavior of patients. Nevertheless, merely approximately half of the individuals affected by the depression receive treatment and the majority of individuals treated often receive treatment in primary care. Even though depression may present in numerous forms, it is associated with the symptoms that include sadness, loss of interest, fatigue, irritability, difficulties in concentration, guilt, changes in appetite and social withdrawal. The symptoms frequently happen episodically as well as cause functional impairment (Maurer et al., 2018).
Substance abuse includes the continuum of use of the substance in excess of the recommended patterns that range from the at-risk consumption to the severe substance utilization disorders. Numerous patients that are identified through screening for abuse of substance will not display considerable substance abuse. The majority of the individuals identified by the positive screenings will show at-risk patterns of the consumption which adversely impact the health and can progress in some of the patients to dependence with no early detection as well as the intervention (Levy & Williams, 2016).
Screening Tools for Depression and Substance Abuse
The Hamilton Depression Rating Scale is the twenty-one item assessment of the depressive symptoms and the score above seven is positive. The scoring of this tool also categorizes the severity of the symptom with 10-13 showing mild symptoms and 14-17 indicating mild to the moderate symptoms as well as above seventeen indicating moderate to severe symptoms. The Hamilton depression rating scale is verified valuable for numerous years as the technique of establishing the depression level of a patient prior to, during and after the treatment. Although this apparatus form lists the 21 items, scoring is centered on the initial seventeen items and it normally takes between fifteen and twenty minutes so as to complete interview as well as score the results (IsHak et al., 2017).
The Alcohol, Smoking and the Substance Involvement Screening Test assess the lifetime history of tobacco, alcohol and drug utilization, cravings for utilization and the consequences linked to the utilization in the following three months duration. The scores of eleven and higher show the need for the brief intervention for alcohol with all the other substances having a lower threshold of four displaying intervention (Levy & Williams, 2016).
My Responsibility as a Primary Care Provider
As the provider of primary care, my duty to the patient once the depression disorder has been identified include the utilization of evidence-centered treatments comprising medications and psychotherapy, involving the patient in the care and education regarding the illness and close follow-up so as to ensure that the patient is improving. I can guarantee that there is commitment so as to keep adjusting the treatments or make consultation with the mental health specialists until the depression is considerably enhanced. Additionally, I can ensure that the medications are prescribed appropriately for enhanced health outcomes and involve in the evidence-centered psychological treatments including the behavioral activation or the problem-solving treatment in the primary care (Barth et al., 2016).
As a provider of the primary care, my responsibility to the patient after substance abuse disorder had been identified comprise offering the most appropriate counseling and prescribing the best medications for treating the disorder. I can involve in more intensive continuing follow-up as well as reevaluation. I can ensure that the patient is referred to as the special treatment and pharmacotherapy when there is substance dependence. Furthermore, I can utilize the motivational style of communication during counseling and treatment for improved patient outcomes (Levy & Williams, 2016).
Depression and substance abuse are the common behavioral health issues which also affect physical health status; nevertheless, they are frequently under-identified within the primary care environments. The untreated depression, as well as substance misuse adversely, impacts the cost and quality of healthcare. The Hamilton Depression Rating Scale is an appropriate tool for screening depression and the alcohol, smoking as well as substance involvement screening test helps in screening substance abuse.
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243.
IsHak, W. W., Collison, K., Danovitch, I., Shek, L., Kharazi, P., Kim, T., … & Nuckols, T. (2017). Screening for depression in hospitalized medical patients. Journal of hospital medicine, 12(2), 118-125.
Levy, S. J., & Williams, J. F. (2016). Substance use screening, brief intervention, and referral to treatment. Pediatrics, 138(1), e20161211.
Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: Screening and Diagnosis. American family physician, 98(8), 508-515.