Qualitative study of an intervention for depression among patients with diabetes: how can we optimize patient-professional interaction?

Objectives: To describe the communication between the depression care specialist (DCS) nurses and patients with both depression and diabetes in an intervention study. Our aims were to inform both the quantitative findings of the present trial and the design of future primary care intervention studies. Methods: Qualitative content analysis of consultations between DCS nurses and patients in nine primary care clinics. Results: Patients experienced a wide range of physical, social and psychological problems. The DCS nurses employed a range of interventions in addition to the problem-solving and case-management skills that formed the basis of this intervention. Conclusions: Patients sometimes posed difficulties in being unable to understand the treatment, unprepared to engage with a new treatment and unready (or even unable) to acquire new skills. To optimize the interaction between patient and professional in the case management of depression and diabetes, training should provide guidance in the use of different models of care (medical and psychological), help case managers to identify and negotiate problem scenarios and combine an active model of therapy such as problem-solving treatment for primary care (PST-PC) with elements from motivational interviewing, ensure effective engagement in treatment, and specifically explore how interaction between depression and diabetes might result in adverse outcomes.