Depressed patients who have poorly controlled diabetes or heart disease — or both — often are some of the most unhappy and expensive patients around.
But when their depression and physical problems are monitored and treated by a team of primary-care providers, these patients not only feel better, their physical condition improves significantly, researchers from the University of Washington and Group Health Cooperative reported last month in the New England Journal of Medicine.
The study, funded by the National Institute of Mental Health, followed 214 Group Health patients with poorly controlled diabetes, coronary heart disease or both, along with depression. The patients were randomly assigned to either standard care or an approach in which nurse care managers coached them, monitored their disease control and depression and worked with their primary-care doctors.
Each patient and the nurse care manager set goals to reduce depression, blood sugar, blood pressure and cholesterol.
The study found that at one year, patients receiving team care not only said they had better quality of life and greater satisfaction with their care, measurements showed they were less depressed and showed significant improvement in blood sugar, blood pressure and cholesterol levels.
“We were very systematic about ‘treating to target,’ ” meaning that when a patient didn’t meet a goal, the nurse manager helped troubleshoot the problem, said Dr. Elizabeth Lin, one of the study’s authors. “If they’re not at target, then the question is ‘Why not?’ “
Other similar studies, including an earlier one by the same researchers, didn’t show improvement in the tests related to diabetes and heart disease, said Lin, a family-medicine doctor and researcher at the Group Health Research Institute and a clinical professor at the University of Washington’s School of Medicine.
The difference, Lin said, was that this study didn’t simply provide patients with attention from a provider, but helped them set and meet goals for improving their blood-sugar, blood-pressure and cholesterol measurements. “Without those specifics, and systematic ways, just providing additional attention or time doesn’t really work,” she said.
A goal is to help cut the costs of treating such complex patients, estimated to be about $10,000 per year, according to study co-author Dr. Wayne Katon, a University of Washington professor of psychiatry and behavioral sciences.
Researchers don’t yet know whether the interventions saved money, Lin said, but they expect, based on previous work, that they will at least prove to be cost- neutral.
Other studies have shown that patients with three or more chronic conditions — a group that includes more than 40 percent of Medicare beneficiaries — account for more than 80 percent of Medicare care costs.
“The problem isn’t just depression, it’s the patient who has coexisting conditions,” Lin said. “That’s becoming such a public-health challenge.”
