Covid-19 and mental health challenges are, unfortunately, terms that have gone hand-in-hand over the past 2 years. Ongoing economic hardships, an alarming spike in syphilis cases and the drastic changes in drinking habits during extended lockdowns have all been put under the microscope as examples of the kinds of toll the pandemic has taken on our mental wellbeing.
Bp Premier features a number of clinical tools which can help. Let’s review some of them, and how they can assist you in supporting patients struggling at this time.
Depression Anxiety Stress Scales (DASS 21)
The latest release of Bp Premier includes the DASS 21 Depression Anxiety Stress Scales (DASS) form, under the Clinical dropdown menu. (This is also where you can access the MMSE Mini Mental State Exam, and the Audit-C questionnaire.)
“DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. It was constructed … to further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states usually described as depression, anxiety and stress.”
Clinical Use of the DASS
“The principal value of the DASS in a clinical setting is to clarify the locus of emotional disturbance, as part of the broader task of clinical assessment. The essential function of the DASS is to assess the severity of the core symptoms of depression, anxiety and stress. It must be recognised that clinically depressed, anxious or stressed persons may well manifest additional symptoms that tend to be common to two or all three of the conditions, such as sleep, appetite, and sexual disturbances. These disturbances will be elicited by clinical examination, or by the use of general symptom check lists as required.”
“The DASS may be administered and scored by non-psychologists, but decisions based on particular score profiles should be made only by experienced clinicians who have carried out an appropriate clinical examination. It should be noted also that none of the DASS items refers to suicidal tendencies because items relating to such tendencies were found not to load on any scale. The experienced clinician will recognise the need to determine the risk of suicide in seriously disturbed person.”
Click here for a full overview of the DASS.
Recording Alcohol Use
When using Bp Premier to record alcohol use, in the Family and Social history tools > Alcohol heading, there are additional resources available to you to assist with diagnosis of alcohol dependency.
The CAGE questionnaire is a list of four simple questions to check for signs of alcohol dependence. The results are recorded in the Comments box on this screen:
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticising your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener), to steady your nerves or to get rid of a hangover?
The AUDIT-C (Alcohol Use Disorders Identification Test) is an alcohol screen that can help identify hazardous drinkers, or those who have active alcohol use disorders. It can also identify at-risk drinkers (e.g. binge drinkers) who may not be alcohol-dependent. It generates a score from 0-12, and there is a button to access explanatory notes to discus with your patients. You can also monitor changes over time.
There is also a button to open a pop up a list of standard drinks sizes for beer, wine, and spirits, plus of course, Fact Sheets (button next to Preventative Health) and Patient Information leaflets (‘professor’ icon in shortcuts toolbar) where you can search by topic and print information and further resources for your patients.
Domestic Violence - Further Support Available for Patients at Risk
Also in the Family and Social History tools, if your patient responds “No” to the question, “Do you feel safe in your own home?” a pop up window will be displayed with contact details for 1800Respect confidential support service.
1800RESPECT will continue to operate as usual during COVID-19, and is open 24 hours to support people impacted by sexual assault, domestic or family violence and abuse. Patients can visit www.1800respect.org.au or call 1800 737 732 at any time.
Ordering Pathology - Setting Up Groups of Tests in Bp Premier
An unexpected event during the Covid-19 crisis has been an alarming spike in Syphilis cases in Australia, so GPs in some areas may be encountering a higher number of patients requiring sexual health checks.
You can save time by setting up ‘favourite’ groups of tests in Bp Premier. To access this, from the main menu, under the Setup dropdown menu > select Preferences > Pathology.
It is very simple to create groups of tests with a single shortcut, so you can generate a pathology request very quickly, e.g. for sexual health checks. To do this, first choose the name for the group, e.g. “STI Check”, then ADD each of the tests you wish to include. A routine STI screen might include these six common STIs detectable through blood and urine analysis: Chlamydia, Gonorrhoea, HIV, Syphilis, Hepatitis B and Hepatitis C.
Recording Covid-19 Vaccinations Given Elsewhere
Another feature you may wish to use is recording Covid-19 vaccine status of your patients. To record vaccines given elsewhere, so they are listed in the patient record, click on the Immunisations heading under Clinical Tree, and ADD a new vaccine. Select which Covid vaccine your patient has received, then under Billing provider dropdown, select “Not given here”.
Vaccines recorded in this way will not be uploaded to AIR from your practice. You do not need to include batch number details, but you can note the date given for each vaccine in the series, and use the comments section to record where the vaccine was administered, e.g. at a Pharmacy or vaccine hub location. You may wish to look at the patient’s vaccine certificate to verify details before recording information in their record.
For patients returning from overseas, click here to provide them with information from Services Australia on getting help adding your overseas COVID-19 vaccinations to the Australian Immunisation Register (AIR).
Though a return to relatively normal life may be in sight for many of us, Covid-19 and mental health continues to be a focus for people still struggling for many reasons, including the ones we’ve touched on today.
Below are a number of helpful links that provide more information around these topics.
Deployment & Training Specialist at Best Practice Software