Integrated Health Care Helps with Depression

Depressive symptoms lesson in patients with chronic illness when health care is made more collaborative

(RxWiki News) Common sense would say that hiring an extra person to oversee a patient’s care would cost a great deal more. However, new research suggests that integrative health care will actually lower cost and improve results in certain cases.

Doctors watch two sets of patients with the same set of health problems for two years to determine if improving the quality of life for patients with chronic illness could be as simple as opening up lines of communication.

Collaborative, patient-centered medicine may not be as expensive as it sounds.

"Talk to your doctor about integrative care clinics. "

Dr. Wayne Katon MD., professor of psychiatry at the University of Washington School of Medicine, and his team did a controlled study on health care costs and outcomes for patients that have depression combined with either coronary heart disease (CHD) or diabetes.

The study was prompted by the realization that patients that have either CHD or diabetes along with depression have more health complications and higher health care costs than CHD or diabetes patients without depression.

Researchers wanted to know what they could do to more efficiently and effectively treat these cases.

Dr. Katon’s team set out to discover whether it reduced the cost of the patients’ care to treat them with a team of health care professions working together in a more ‘patient-centered’ setting rather than the traditional method of specialization and separation for patient care.

Study authors claim, “The 27 percent of adult American with 2 or more chronic medical illnesses now account for approximately 65 percent of total health care spending. Yet, most quality improvement efforts developed to enhance disease control and outcomes of chronic illness have focused on single conditions, such as diabetes or congestive heart failure.

New interventions are needed that focus on primary care patients with commonly occurring multiple illnesses associated with adverse outcomes.”

214 adults with depressive disorder and ‘poorly controlled’ diabetes or CHD were enrolled into the study that would be conducted at 14 different integrated health care clinics.

The goal was to improve depression scores, hemoglobin A1c levels, blood pressure rate and cholesterol levels over the course of 2 years in an integrated style medical setting.

A big part of integrated care had to do with nurse care managers working with physicians to make sure that each patient was being evaluated with all illnesses and complications in mind.

Compared to the control group that underwent traditional care for their conditions, the integrated group reported an average of 114 extra depression free days. The integrated patients’ hemoglobin A1c, blood pressure and cholesterol levels lowered the first year compared to the control group, and then remained about the same for the second year of the study.

The integrated patients’ total outpatient healthcare costs were an average of $594 less per patient over the course of the study compared to the control group. This study demonstrated that the quality of life was improved at a reduced cost simply due to the style of treatment the patients received and methodology of medical communication.

This study will be published in the Archives of General Psychiatry, May 2012. Funding for this research was supported by grants from the Services Division of the National Institute of Mental health.

Financial disclosure of the study states that: “Dr. Katon has received support to serve on advisory boards from Eli Lilly and Wyeth and has received honoraria for lectures from Pfizer, Forest, Eli Lilly, and Wyeth. Dr. Lin served on an advisory board for Physicians Postgraduate Press, receives honoraria for lectures, and has received funds for preparing a manuscript for the following companies: Institute of Clinical Systems Improvement, Prescott Medical, and HealthStar Communications (Eli Lilly). Dr. Ciechanowski serves on the editorial boards of Diabetic Living and Diabetes Forecast, owns Samepage and has a patent for his company, receives lecture fees from Rewarding Health, and receives travel fees from Roche Diagnostics.

Dr. Von Korff receives support from grants to the Group Health Research Institute from Johnson & Johnson Inc for developing a risk score for chronic pain prognosis and a study of acetaminophen use.”

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Review Date: 
May 5, 2012