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Collaborative care for patients with depression and chronic illnesses
Wayne J Katon1, Elizabeth H B Lin, Michael Von Korff
1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. wkaton@u.washington.edu
The New England Journal of Medicine
|December 31, 2010
Summary
Coordinated care management significantly improved control of chronic diseases like diabetes and heart disease, alongside depression, in a randomized trial. This patient-centered approach enhanced overall health and satisfaction for participants.
Area of Science:
- Internal Medicine
- Psychiatry
- Health Services Research
Background:
- Patients with coexisting depression and chronic conditions like diabetes or coronary heart disease face higher risks and healthcare costs.
- Effective management strategies are crucial for improving outcomes in this complex patient population.
Purpose of the Study:
- To evaluate the effectiveness of a coordinated care management intervention for patients with poorly controlled diabetes, coronary heart disease, or both, and coexisting depression.
- To determine if this collaborative approach improves disease control and patient well-being.
Main Methods:
- A single-blind, randomized controlled trial was conducted across 14 primary care clinics.
- 214 participants were assigned to either usual care or an intervention group receiving nurse-led, collaborative care management.
- The primary outcome measured simultaneous improvements in glycated hemoglobin, LDL cholesterol, systolic blood pressure, and depression scores (SCL-20) at 12 months.
Main Results:
- The intervention group showed significantly greater improvements in glycated hemoglobin, LDL cholesterol, systolic blood pressure, and depression scores compared to the usual-care group.
- Patients in the intervention group were more likely to have medication adjustments for diabetes, hypertension, and depression.
- Improved quality of life and higher satisfaction with care for both chronic diseases and depression were reported by the intervention group.
Conclusions:
- Guideline-based, patient-centered management by nurses significantly improved the control of both chronic medical conditions and depression.
- Coordinated care management offers a superior approach compared to usual care for patients with multiple comorbid conditions.
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