Nurses lead successful collaborative-care intervention for depressed patients with chronic conditions

TEAMcare, a primary care intervention in which nurses help health teams use evidence-based guidelines to simultaneously treat depression and physical disease improved patients' mental health, as well as their blood glucose, LDL cholesterol and systolic BP levels.

“Depressed patients with multiple uncontrolled chronic diseases are at high risk of heart attack, stroke and other complications,” study researcher Wayne J. Katon, MD, a professor of psychiatry and behavioral sciences at the University of Washington and also an affiliate investigator at Group Health Research, both in Seattle, said in a press release.

Katon and colleagues compared depression outcomes and risk factors associated with multiple diseases between patients who received the TEAMcare intervention (n=105) and those who received usual care (n=106), during a one-year period at 14 primary care facilities in Washington State. Results were published in New England Journal of Medicine's Dec. 30 issue.

Patients in the TEAMcare intervention group were assigned to a nurse-care manager who worked with them to establish realistic step-by-step goals to manage depression, blood sugar, BP and cholesterol through improved medication adherence and self-care.

“These four disease-control measures are associated with an increased risk of complications and death among patients with diabetes coronary heart disease or both,” the researchers wrote.

Using a “treat to target” approach, nurses then worked with a team of psychiatrists, psychologists and a supervising physician to make personalized recommendations concerning medication dose and type to each patients' primary care doctors.

During the study, intervention patients were more likely to have medications adjusted, including insulin (P=0.006), antihypertensives (P<.001) and antidepressants (P<.001).

Furthermore, the researchers found that patients in the TEAMcare intervention group were more likely to have either clinically significant improvements, or values lower than recommended guidelines, compared with control patients (37% vs. 22%) on all three measured medical outcomes, as follows:

  • A higher proportion of intervention patients experienced a more than 50% or greater reduction in depression scores on the Symptom Checklist-20.
  • More intervention patients were likely to have a 1% or greater decrease in glycated hemoglobin levels compared with baseline than control patients.
  • More intervention patients were likely to have a decrease of 10 mm Hg or greater in systolic BP compared with baseline than control patients.

Intervention patients also reported a better quality of life (P<.001) and greater satisfaction with the care that they received for diabetes, coronary heart disease or both, as well as with care for depression (P<.001).

“TEAMcare is a truly patient-centered approach that enhances a primary care team to deliver optimal care for both physical and mental health in a seamless manner,” study researcher and Group Health family physician, Elizabeth H.B. Lin, MD, MPH, said in a press release. “It recognizes there can be no health without mental health.”

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