Among adults with depression and poorly controlled diabetes mellitus, coronary heart disease, or both, a collaborative care intervention incorporating a team-centered care approach is associated with improvements in depression-free days and quality-adjusted life-years, according to a report in the May issue of Archives of General Psychiatry, a JAMA Network publication.
"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," the authors write as background information in their study.
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 randomized to the intervention group received a patient-centered, team-based collaborative care management that included nurse care managers who worked with the patients and their primary care physician to optimize the systematic management of chronic illness. Nurses tracked patient progress and reviewed each case weekly with a consulting psychiatrist and internist or family physician. Patients randomized to the control group received usual 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 follow-up, however HbA1c, LDL-C and SBP levels were not significantly different between the two groups.
Over 24 months, compared with patients in the control group, patients in the intervention group had an average of 114 additional depression-free days, and 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 24 months. The authors also found that patients in the intervention group had lower average outpatient health care costs of an estimated $594 per patient compared with patients receiving usual care.
"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," the authors conclude.
(Arch Gen Psychiatry. 2012;69[5]:506-514. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This research was supported by grants from the Services Division of the National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact Wayne Katon, M.D., call Leila Gray at 206-685-0381 or email leilag@uw.edu.
Journal
Archives of General Psychiatry