Follow-up calls track the success of therapy

To determine whether electroconvulsive therapy (ECT) is helping patients months after it is administered, staff in the ECT department at Sacred Heart Medical Center in Spokane, WA, began conducting follow-up calls at two-week, six-week, and six-month intervals following therapy.

The long-term success of the treatments were calculated with the aid of a questionnaire, which patients completed prior to ECT and during each follow-up call, says Barbara Stagg, RN, charge nurse in the ECT department.

The questionnaire, called a Bech Depression Scale, has 21 categories that cover emotional and physical symptoms and each has four choices for patients to choose from. For example, to help determine a patient’s emotional state he or she would be asked to select the statement that best mirrors his or her outlook from the following selections:

  • I am not particularly discouraged about the future.
  • I feel discouraged about the future.
  • I feel I have nothing to look forward to.
  • I feel the future is hopeless and things cannot improve.

Statements to uncover physical symptoms that indicate depression, such as fatigue, include:

  • I don’t get more tired than usual.
  • I get more tired more easily than I used to.
  • I get tired from doing almost anything.
  • I am too tired to do anything.

Although the follow-up calls were initiated in 1999 to determine if ECT was working on patients with major depression who often have a borderline personality disorder, it proved so beneficial that the practice was continued.

A lot of mentally ill people don’t have a good support network and end up back in the same lifestyle and old behavior patterns that may initiate depression. "We have caught a couple people who have isolated themselves and are almost suicidal again," says Stagg.

To help prevent depression, these patients often are asked to do a maintenance treatment where they return to the ECT department once a month or once every several months depending on their support system. Some may have a counselor and a caseworker. Those who have strong family support do better as well.

The RNs on staff at the ECT department make the follow-up calls. Administration had asked that a secretary make the calls but a layperson is not equipped to respond to emergencies such as a suicidal patient, said Stagg. "The patients know us and give us a better, more truthful report of what they are doing," she says. The calls take from 10-25 minutes.

A chart tracks the names of each patient and the date the first test was given, then the dates for the two-week, six-week, and six-month follow-up calls are listed. During the initial treatment patients are asked for the phone numbers of relatives and friends so that staff can reach them if they should move, which often occurs.

"Although we started the follow-up calls as a study, they have become much more than that," says Stagg.

Source

For more information about follow-up calls to track therapy success, contact:

  • Barbara Stagg, RN, Charge Nurse, Sacred Heart Medical Center, Spokane, WA. Telephone: (509) 474-3037. E-mail: staggb@shmc.org.