A study published in the May issue of Archives of General Psychiatry, reveals that individuals with depression and poorly controlled diabetes mellitus, coronary heart disease, or both, can benefit from a collaborative care intervention.
The intervention, which includes a team-centered care approach, was shown to improve the number of depression-free days in these patients, as well as quality-adjusted life-years.
The researchers explained:
“Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD) or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life.”
A randomized controlled trial was conducted by Wayne Katon, M.D., of the University of Washington School of Medicine, Seattle, and his team in order to examine a systematic intervention designed to enhance disease control of depression, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c (HbA1c) in individuals suffering from depression and poorly controlled diabetes mellitus, CHD or both.
The researchers randomly assigned participants to either the intervention group or the controlled group. Participants in the control group received usual care and were advised to consult with their primary care provider to receive care. Those assigned to the intervention group received patient-centered, team-based collaborative care management that included nurse care managers who worked together with the participants and their primary care physician in order to improve the systematic management of chronic illness.
During the first 12 months, the researchers found that improvements in depression scores HbA1c, LDL-C and SBP levels were considerably greater among participants assigned to the intervention group compared with those in the control group.
In addition, at 18 and 24 months follow-up, the team found that depression scores remained considerable lower among patients in the intervention group vs. the control group. However, they found no significant differences in HbA1c, LDL-C and SBP levels between the intervention and control group.
According to the researchers, patients in the intervention group had an average of 114 additional depression free days over a 24 month period, compared with patients assigned to the control group, as well as an estimated 0.335 additional quality-adjusted life-years (QALYs).
The team based QALYs on changes in depression-free days, HbA1c, LDL-C and SBP levels over 24 months.
Furthermore, results showed that the average outpatient health care costs were lower ($594 per patient) in the intervention group than in the control group.
The researchers conclude:
“For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA1c, SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs.”
Written By Grace Rattue