Study coordinates depression treatment with disease care

A study in the New England Journal of Medicine suggests that patients do significantly better when their depression is treated in conjunction with their diabetes or heart disease.

Patients with heart disease or diabetes who suffer from depression as well are notoriously difficult to treat: They have more severe complications and a higher mortality rate than patients who aren’t depressed.

But help may be on the way. Research published Wednesday in the New England Journal of Medicine suggests that coordinating care to manage depression and chronic illness — together, at the same time — produces better outcomes for patients.

“Up to this point, most care management has been focused on one condition at a time,” said study coauthor Dr. Elizabeth Lin, a primary-care physician and researcher with Group Health Cooperative, a nonprofit healthcare organization based in Seattle.

In the study, researchers recruited 214 patients with depression and heart disease, depression and diabetes, or both, from 14 primary-care clinics within the Group Health network.

About half of the patients received coaching from a specially trained nurse to help them meet goals to improve their depression as well as diabetes and/or heart disease. The other half received standard care and were not assigned a nurse care manager.

Over the course of the 12-month program, the researchers measured the patients’ blood sugar, LDL cholesterol, blood pressure and levels of depression. The patients who worked with a nurse care manager had better blood sugar control, as well as significantly lower blood pressure, cholesterol and depression than those who didn’t get the special coaching.

“The study really shows a significant impact,” said Dr. Andrew Leuchter, a professor of psychiatry at UCLA. “They really completely overhauled how healthcare was delivered in this system.”

Lin said the team focused on diabetes, heart disease and depression because those are the most common chronic illnesses among the Medicare population. The conditions seem to compound each other.

“When patients have depression on top of heart disease and diabetes it’s a double-whammy,” Lin said.

Such patients have more severe complications and higher mortality, she said, because people who are depressed tend to be less active, smoke more and have poor diets, and often don’t follow directions when taking medication.

Also, Lin added, there’s emerging evidence that depression triggers hormones that increase heart rate and blood pressure, and disrupt glucose control.

Although there was additional cost associated with the program — the estimated average expense per patient was $1,224 — Lin said the improved outcomes potentially could save health systems money. Patients with three or more chronic conditions — 43% of Medicare beneficiaries — account for more than 80% of Medicare healthcare costs, the study noted.

But in the push to cut costs in the short term, many healthcare services may balk despite the fact that patients do better, Leuchter said.

“The problem is, the whole push in healthcare is to do things faster and cheaper,” Leuchter said. “There is no push to spend more time with patients.”

By Eryn Brown
Los Angeles Times

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