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Developing a New Neuromodulation Treatment Pathway for the Treatment of Depression

Published online by Cambridge University Press:  20 June 2022

Andreas Papadopoulos*
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Nathan Maynard
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Samuel Lawton
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Tiff Earle
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Stephen De Souza
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Sarah Oke
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
Jane Yeandle
Affiliation:
Somerset NHS Foundation Trust, Somerset, United Kingdom
*
*Presenting author.
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Abstract

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Aims

To ensure an appropriate treatment pathway is available to patients diagnosed with Depression a STEPPED care model where different types of intervention are offered depending on the patient's experienced severity of Depression. However, a great percentage of patients continue to experience disabling symptoms and fall into the Treatment Resistant Depression (TRD) category. There was a need to review the options available within local Mental Health Services (MHS) for the treatment of patients with depression and TRD.

Methods

A new clinical pathway was designed to provide access to patients to emerging treatments, such as EsKetamine, Vagal Nerve Stimulation (VNS) and repetitive Transcranial Magnetic Stimulation (rTMS). After calculating the local impact of depression to patients, trust resources and society we extrapolated our calculations to neighbouring Trusts covering the South West. A newly developed business plan demonstrating the need for new treatment options and the benefits, financial and otherwise, was presented and underwent various approvals levels by the Trust Governance and Executive Committees and local commissioning groups, before being able to proceed. Within the original business plan, rTMS and VNS were offered in addition to the existing ECT as parts of a new treatment pathway. We are now in the process of incorporating EsKetamine and Transcranial Direct Current Stimulation (tDCS). The clinic was set up in March 2020, just at the beginning of the pandemic, which halted operations for quite a few months before being able to resume recently

Results

We have managed to treat patients with both VNS and rTMS from our Trust, as well from surrounding areas. Patients have already experienced benefits in the recovery from symptoms. The new service has provided another line of support for colleagues in offering bespoke treatment plans to their patients and patients have appreciated having access to new non-traditional treatment options.

Conclusion

Although there has been a primary result in improving patient care, income generation is also possible by positioning the Trust in the forefront of new therapeutics and allowing the provision of service to expand to neighbouring Trusts and private patients. Other benefits are associated with the Trust's reputations and kudos being enhanced and include the forging of new pathways within the developing alliance with General Hospitals, increased ‘visibility’ for training and research opportunities, improved patient satisfaction and improved CQC standing.

Type
Quality Improvement
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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