A team-centered health care approach can increase depression-free days and overall quality of life among adults with depression and poorly controlled diabetes, heart disease or both.
Such patients “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,” according to a report in the May issue of Archives of General Psychiatry.
Wayne Katon, M.D., of the University of Washington School of Medicine, Seattle, and colleagues conducted a randomized controlled trial of a systematic intervention to improve disease control of depression, hemoglobin A1c (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) in patients with poorly controlled diabetes mellitus, CHD, or both and comorbid depression.
Patients in the intervention group received patient-centered, team-based collaborative care. Nurse care managers worked with the patients and their primary care physician to assist with optimal chronic illness management.
Nurses tracked patient progress and reviewed each case weekly with a consulting psychiatrist and internist or family physician. Patients in the control group received standard care and were advised to consult with their primary care provider to receive care.
Compared with patients in the control group, patients in the intervention group had significantly greater improvements among depression scores, HbA1c, LDL-C and SBP levels during the first 12 months.
Depression scores remained significantly lower in the intervention group compared to the control group at 18- and 24-months followup; however HbA1c, LDL-C and SBP levels were not significantly different between the two groups.
Compared with patients in the control group, patients in the intervention group had an average of 114 additional depression-free days over 24 months. They also had an estimated 0.335 additional quality-adjusted life-years (QALYs).
The QALYs were based on changes in depression-free days over 24 months and the changes in HbA1c, LDL-C and SBP levels over the same time period. The authors also found that patients in the intervention group had lower average outpatient health care costs (approximately $594 per patient) compared with patients receiving usual care.
Source: Arch Gen Psychiatry. 2012;69:506-514.