NIMH · Case-managed Care Improves Outcomes for Depressed Patients with Multiple Medical Conditions

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Science Update • December 30, 2010

Case-managed Care Improves Outcomes for Depressed Patients with Multiple Medical

Conditions

People with diabetes or heart disease plus depression fare better if their

medical care is coordinated by a care manager who also educates patients about

their condition and provides motivational support, compared to those who receive

care from their primary care physician only, according to an NIMH-funded study

published December 30, 2010, in the New England Journal of Medicine.

Background

Coexisting depression is common among patients with diabetes or heart disease,

especially if their medical conditions are poorly controlled. Having depression

puts these patients at higher risk for poor self-care and more medical

complications, and a higher risk for death. Patients dealing with multiple

chronic conditions also tend to incur higher medical costs.

Wayne Katon, M.D., of the University of Washington, and colleagues at Group

Health Research Institute in Seattle developed a team-based intervention

approach—TEAMcare—that aimed to improve medical outcomes and ease depression

symptoms among these patients. They tested the intervention in a randomized

controlled trial of 214 participants in 14 primary care clinics in Washington

state. The participants all had poorly controlled diabetes and/or heart disease

with coexisting depression.

Half of the patients were randomized to a 12-month trial of TEAMcare, in which a

medically supervised nurse care manager coordinated their care with their

primary care provider (PCP) and other medical professionals. The nurse care

manager also helped patients set goals for controlling their medical conditions,

provided motivation and education about taking their medications correctly,

consulted with patients' PCPs about changes in medications recommended by

supervisors, and encouraged better self-care. The other half of the participants

received usual care, in which their PCP consulted with them about depression

care and medical disease control, but they did not have a nurse care manager

coordinating their care.

Results of the Study

Overall, patients in the TEAMcare intervention fared better than those in usual

care. Symptoms of depression eased in the TEAMcare group more so than in the

usual care group. Patients in the TEAMcare intervention also showed greater

improvements in blood glucose levels, blood pressure and " bad " cholesterol

levels, compared to patients in usual care. Patients in TEAMcare were also more

likely to have their medications adjusted, indicating a desire to fine-tune

their care to achieve better results. TEAMcare patients also reported greater

satisfaction with their medical care and a higher quality of life.

Significance

Previous research suggests that patients who are more satisfied with their

medical care tend to be more motivated to take better care of themselves and

therefore have better outcomes. According to the researchers, TEAMcare offers a

promising way of improving outcomes in patients with multiple medical illnesses

and depression because it provides systematic patient support as well as

assistance to PCPs.

The researchers also note that patients with multiple medical conditions tend to

have high health care costs. The study results suggest that a proactive,

coordinated intervention like TEAMcare may facilitate better, more efficient

care of these patients in particular.

What's Next

TEAMcare was tested among a specific population enrolled in one health plan,

using highly trained nurse care managers. Further study is needed to determine

whether the approach can be cost-effectively applied to broader populations, and

whether less experienced nurse care managers could be used without sacrificing

quality of care.

Reference

Katon WJ, Lin EHB, Von Korff M, Ciechanowski P, Ludman EJ, Young B, D,

Rutter CM, McGregor M, McCulloch D. Multi-condition collaborative care for

chronic illnesses and depression. New England Journal of Medicine. Dec. 30,

2010.

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