TY - JOUR
KW - Antidepressive Agents/therapeutic use
KW - Antihypertensive Agents/therapeutic use
KW - Blood Pressure
KW - Cholesterol, LDL/blood
KW - Chronic Disease
KW - Cooperative Behavior
KW - Coronary Disease/blood/physiopathology/psychology/therapy
KW - Depressive Disorder, Major/complications/nursing/physiopathology/therapy
KW - Diabetes Mellitus/blood/physiopathology/psychology/therapy
KW - Hemoglobin A, Glycosylated/analysis
KW - Humans
KW - Patient Care Team
KW - Patient-Centered Care/methods
KW - Primary Health Care
KW - Risk Factors
KW - Single-Blind Method
AU - W. J. Katon
AU - E. H. Lin
AU - M. Von Korff
AU - P. Ciechanowski
AU - E. J. Ludman
AU - B. Young
AU - D. Peterson
AU - C. M. Rutter
AU - M. McGregor
AU - D. McCulloch
A1 - 
AB - BACKGROUND: Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes and high health care costs. We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients. METHODS: We conducted a single-blind, randomized, controlled trial in 14 primary care clinics in an integrated health care system in Washington State, involving 214 participants with poorly controlled diabetes, coronary heart disease, or both and coexisting depression. Patients were randomly assigned to the usual-care group or to the intervention group, in which a medically supervised nurse, working with each patient's primary care physician, provided guideline-based, collaborative care management, with the goal of controlling risk factors associated with multiple diseases. The primary outcome was based on simultaneous modeling of glycated hemoglobin, low-density lipoprotein (LDL) cholesterol, and systolic blood-pressure levels and Symptom Checklist-20 (SCL-20) depression outcomes at 12 months; this modeling allowed estimation of a single overall treatment effect. RESULTS: As compared with controls, patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels (difference, 0.58%), LDL cholesterol levels (difference, 6.9 mg per deciliter [0.2 mmol per liter]), systolic blood pressure (difference, 5.1 mm Hg), and SCL-20 depression scores (difference, 0.40 points) (P<0.001). Patients in the intervention group also were more likely to have one or more adjustments of insulin (P=0.006), antihypertensive medications (P<0.001), and antidepressant medications (P<0.001), and they had better quality of life (P<0.001) and greater satisfaction with care for diabetes, coronary heart disease, or both (P<0.001) and with care for depression (P<0.001). CONCLUSIONS: As compared with usual care, an intervention involving nurses who provided guideline-based, patient-centered management of depression and chronic disease significantly improved control of medical disease and depression. (Funded by the National Institute of Mental Health; ClinicalTrials.gov number, NCT00468676.).
BT - The New England journal of medicine
C5 - General Literature
CP - 27
CY - United States
DO - 10.1056/NEJMoa1003955
IS - 27
JF - The New England journal of medicine
N2 - BACKGROUND: Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes and high health care costs. We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients. METHODS: We conducted a single-blind, randomized, controlled trial in 14 primary care clinics in an integrated health care system in Washington State, involving 214 participants with poorly controlled diabetes, coronary heart disease, or both and coexisting depression. Patients were randomly assigned to the usual-care group or to the intervention group, in which a medically supervised nurse, working with each patient's primary care physician, provided guideline-based, collaborative care management, with the goal of controlling risk factors associated with multiple diseases. The primary outcome was based on simultaneous modeling of glycated hemoglobin, low-density lipoprotein (LDL) cholesterol, and systolic blood-pressure levels and Symptom Checklist-20 (SCL-20) depression outcomes at 12 months; this modeling allowed estimation of a single overall treatment effect. RESULTS: As compared with controls, patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels (difference, 0.58%), LDL cholesterol levels (difference, 6.9 mg per deciliter [0.2 mmol per liter]), systolic blood pressure (difference, 5.1 mm Hg), and SCL-20 depression scores (difference, 0.40 points) (P<0.001). Patients in the intervention group also were more likely to have one or more adjustments of insulin (P=0.006), antihypertensive medications (P<0.001), and antidepressant medications (P<0.001), and they had better quality of life (P<0.001) and greater satisfaction with care for diabetes, coronary heart disease, or both (P<0.001) and with care for depression (P<0.001). CONCLUSIONS: As compared with usual care, an intervention involving nurses who provided guideline-based, patient-centered management of depression and chronic disease significantly improved control of medical disease and depression. (Funded by the National Institute of Mental Health; ClinicalTrials.gov number, NCT00468676.).
PP - United States
PY - 2010
SN - 1533-4406; 0028-4793
SP - 2611
EP - 2620
EP - 
T1 - Collaborative care for patients with depression and chronic illnesses
T2 - The New England journal of medicine
TI - Collaborative care for patients with depression and chronic illnesses
U1 - General Literature
U2 - 21190455
U3 - 10.1056/NEJMoa1003955
VL - 363
VO - 1533-4406; 0028-4793
Y1 - 2010
ER -