RESEARCH In patients with either type 2 diabetes mellitus or coronary heart disease the presence of depression leads to increased morbidity and mortality. 1,2 This comorbid depression is often missed in routine general practice. 3 To address these problems we describe the implementation of collaborative care based on new roles for practice nurses (PNs), information technology solutions, and a shift of focus toward self care. A similar model of collaborative care has been shown overseas to be an effective way to improve the management of depression in primary care. 4 Method A feasibility study focusing on additional roles for PNs. Six practices in southeast Australia were selected by invitation on the basis of having PNs available to participate in the study. Patients were selected by the general practitioner from a disease registry or opportunistically invited to attend the PN before review by the usual doctor. Regular follow up checks by the PN/doctor team were organised at 3–6 month intervals according to clinical need. The GP Management Plan template allowed de-identified collection and feedback of data, as well as prompting review appointments. Structured interviews were conducted with all PNs and GPs in the study to evaluate the usefulness of the collaborative model. Ethics approval was obtained from the Flinders University Social and Behavioural Research Ethics Committee. The workshops Nurse training workshops prepared PNs for new roles including: • use of the Patient Health Questionnaire (PHQ-9) 5 to detect and monitor depression and to assist the GP in clinical treatment of depression • physical checks and pathology results checklist generated from National Heart Foundation and Diabetes Australia guidelines • coordinating and ensuring follow up and appropriate allied health referrals • helping patients understand and set goals related to depression, lifestyle changes, and targets for physical and chemical measures • drafting a GP Management Plan Background Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases. Method A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression. Results The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care. Discussion Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care. Collaborative care The role of practice nurses Prasuna Reddy PhD, MAPS, is Director of Research, Greater Green Triangle, University Department of Rural Health, Flinders and Deakin Universities, Victoria. James Dunbar MD, FRCP(Edin), FRCGP, FRACGP, FACRRM, is Director, Greater Green Triangle, University Department of Rural Health, Flinders and Deakin Universities, Victoria. director@greaterhealth.org Mark A J Morgan BM, BCh, MA, FRACGP, is Senior Research Fellow and general practitioner, Greater Green Triangle, University Department of Rural Health, Flinders and Deakin Universities, Victoria. Reprinted from AUSTRALIAN FAMILY PHYSICIAN Vol. 38, No. 11, November 2009 925 Archived at Flinders University: dspace.flinders.edu.au Text and images copyright of Australian Family Physician. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners. Morgan, M., Dunbar, J.A. & Reddy, P. 2009. Collaborative Care: The Role of Practice Nurses. Australian Family Physician, 38 (11), 925-926. Copyright 2009, Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners. Available online at: http://www.racgp.org.au/afp