How does team care improve depression and diabetes?
The growing number of people with multiple physical and mental chronic conditions are among the toughestand costliestto care for. The TEAMcare collaborative care program is a promising solution. In the January/February 2012 Annals of Family Medicine, Group Health Research Institute and UW Medicine researchers have found how this program works: through primary-care doctors starting and adjusting medications sooner and more often to reach goals ("treating to target"); and motivating patients to participate in their own care and monitor their illnesses.
"We have shown that it's effective when nurses work with patients and health teams to manage care for depression and physical diseases together, using evidence-based guidelines," said Elizabeth H.B. Lin, MD, MPH, a Group Health family physician and an affiliate investigator at Group Health Research Institute.
With Wayne J. Katon, a UW professor of psychiatry and behavioral sciences and an affiliate investigator at Group Health Research Institute, Dr. Lin and others published a randomized controlled trial in the New England Journal of Medicine. They reported that TEAMcare resulted in less depression and better-controlled blood pressure, sugar, and cholesterol levels for 214 Group Health Cooperative patients with depression and diabetes and/or heart disease.
With Michael Von Korff, ScD, a senior investigator at Group Health Research Institute, the same research group also published in the British Medical Journal that these patients had better quality of life and less disability than did patients with usual care. "These are the outcomes that matter most to patients," Dr. Lin said. And they suggest that TEAMcare may help people with multiple chronic diseases to age in the healthiest possible way.
"Now we've shown why this team-based care is effective," Dr. Lin said. "It's because it activates patients to check their own blood pressure and sugar moreand primary-care doctors to adjust patients' medications sooner and more often."
After a year of the program, medication was six times more likely to be started or adjusted for antidepressants, three times more likely for insulin, and nearly two times more for antihypertensive medications among TEAMcare relative to usual care patients. And TEAMcare patients monitored their own blood pressure three times more often and their blood glucose on significantly more days per week.
"We found no difference in medication adherence between the TEAMcare patients and those with usual care," Dr. Lin said. This may be because adherence rates were already high for both groups at baseline: 79 percent to 86 percent, depending on the drug class. "But in other settings, where medication adherence is lower, helping patients to stick more closely to their prescriptions would likely be more important," she added.
"When patients are depressed and have multiple uncontrolled chronic diseases, they are at high risk of heart attack, stroke, and other complications," Dr. Lin said. "Multiple health problems can feel overwhelmingfor patients, their families and their health care providers. It is hard for primary-care doctors to manage these patients without support like TEAMcare. That support coordinated care, empowered patients to control their diseases better, and helped primary-care doctors to collaborate with various specialists, monitor progress closely, and adjust medications to treat to individualized goals.
"Interest is high in spreading integrated, coordinated, team-based care for patients with depression and poorly controlled physical diseases," Dr. Lin said. She is leading a project to implement TEAMcare as part of usual primary care at Group Health, and there is also interest in spreading the program to other organizations.
TEAMcare is a patient-centered program that is based on the Chronic Care Model and "treating to target": Together, the nurse and patient set realistic step-by-step goals: improving function and quality of life and reducing depression and blood sugar, pressure, and cholesterol levels. To reach these goals, the nurse regularly monitored the patient's mental and physical health. Based on guidelines that promoted incremental improvements, the multidisciplinary care team offered recommendations to the patient's primary care doctor to consider treatment changes to manage blood pressure, blood sugar, lipids, or depression.
Journal reference: New England Journal of Medicine
Provided by Group Health Research Institute
- Team-based approach to care shows success in fight against depression with diabetes, heart disease Dec 30, 2010 | not rated yet | 0
- Online messaging delivers follow-up care for depression Mar 16, 2011 | not rated yet | 0
- Mental health treatment extends lives of older patients with diabetes and depression Dec 05, 2007 | not rated yet | 0
- Integrated health care delivery system and electronic health records support medication adherence Sep 06, 2011 | not rated yet | 0
- Depression associated with poor medication adherence in patients with chronic illnesses May 10, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
After studying noise in one French Quarter neighborhood of New Orleans to determine whether or not noise levels exceeded municipal ordinances, Annette Hurley, PhD, Assistant Professor of Audiology at LSU Health Sciences Center ...
Health 1 hour ago | not rated yet | 0
Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits, according to a study published today in the American Jo ...
Health 1 hour ago | not rated yet | 0
The individualisation of drug treatments to support patients to self-manage their conditions is a concept that sits at the heart of policy, but a recent study in BMJ Open shows that there is no concrete defini ...
Health 3 hours ago | 3 / 5 (1) | 0
Fun in the summer often means kids spending time in the water, whether at a pool, the beach, a lake or river. A pediatric safety expert at the University of Alabama at Birmingham (UAB) stresses proper training ...
Health 4 hours ago | not rated yet | 0
A new way of interpreting information from a low-tech, age-old method used in pregnancy care is expected to more accurately identify potential health issues for mothers and babies.
Health 4 hours ago | not rated yet | 1
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
49 minutes ago | not rated yet | 0 |
(HealthDay)—Menopausal hormone therapy should not be used for prevention of coronary heart disease, according to a Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG) published ...
55 minutes ago | not rated yet | 0
(HealthDay)—We've all seen them: the surfers who race to the beach when a hurricane hits, the guy who decides to ride out the storm in his overmatched boat, the tornado chasers who fearlessly steer their ...
5 minutes ago | not rated yet | 0
Cancer cells spread and grow by avoiding detection and destruction by the immune system. Stimulation of the immune system can help to eliminate cancer cells; however, there are many factors that cause the immune system to ...
23 minutes ago | not rated yet | 0
In recent years, microRNAs (miRNAs) and other non-coding RNAs are small molecules that help control the expression of specific proteins. In recent years they have emerged as disease biomarkers. miRNA profiles have been used ...
21 minutes ago | not rated yet | 0
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
1 hour ago | 5 / 5 (1) | 0 |