A treatment team headed by an experienced nurse improves the health of patients suffering from multiple chronic illnesses such as heart disease, diabetes and depression.
A treatment team headed by an experienced nurse improves the health of patients suffering from multiple chronic illnesses such as heart disease, diabetes and depression.
People with chronic illnesses often don't get optimal care in primary-care settings. In primary-care clinics, at least 50 percent of people with diabetes have blood sugars above guidelines and many people with high blood pressure don't get enough pills or aren't taking them. Similarly with depression, only about one-quarter of people get guideline-level care in primary care.
A team-based, collaborative care strategy has been shown to work in control of heart disease, of diabetes or with depression, but no one has yet looked at all three in tandem. Depression typically goes along with a lot of other medical conditions, tends to interact with those conditions, complicates treatment and worsens the outcomes. Even death rates are higher among people who suffer depression along with another chronic illness, such as heart disease.
Researchers randomised 214 patients in Washington to receive usual care in a primary-care setting or to get the collaborative care approach, called TEAMcare. Those in the TEAMcare group were assigned to a nurse trained in all three conditions who worked with a primary care physician to monitor medication and lifestyle changes.
At the end of 12 months, it was found that patients in the team group saw improved blood sugar control, better LDL (bad) cholesterol levels, lower systolic blood pressure and improvement with their depression. Although the trial didn't last long enough to track actual health outcomes, the researchers pointed out that improving these four measures has been associated in the past with fewer complications and death. There were improvements in the four areas of blood sugar, blood pressure, cholesterol control and depression in middle-aged patients offered this treatment strategy. The intervention patients were less disabled at the end of one year, rated their quality of life as higher and were more satisfied with medical care.
Implementation is the catch here as such an approach requires a lot of steps like coordination of resources, an excellently trained nurse practitioner, a nephrologist and other specialists, etc. The TEAMcare approach is costly so the researchers are now in the process of analysing whether this actually saves the system any money.
People with chronic illnesses often don't get optimal care in primary-care settings. In primary-care clinics, at least 50 percent of people with diabetes have blood sugars above guidelines and many people with high blood pressure don't get enough pills or aren't taking them. Similarly with depression, only about one-quarter of people get guideline-level care in primary care.
A team-based, collaborative care strategy has been shown to work in control of heart disease, of diabetes or with depression, but no one has yet looked at all three in tandem. Depression typically goes along with a lot of other medical conditions, tends to interact with those conditions, complicates treatment and worsens the outcomes. Even death rates are higher among people who suffer depression along with another chronic illness, such as heart disease.
Researchers randomised 214 patients in Washington to receive usual care in a primary-care setting or to get the collaborative care approach, called TEAMcare. Those in the TEAMcare group were assigned to a nurse trained in all three conditions who worked with a primary care physician to monitor medication and lifestyle changes.
At the end of 12 months, it was found that patients in the team group saw improved blood sugar control, better LDL (bad) cholesterol levels, lower systolic blood pressure and improvement with their depression. Although the trial didn't last long enough to track actual health outcomes, the researchers pointed out that improving these four measures has been associated in the past with fewer complications and death. There were improvements in the four areas of blood sugar, blood pressure, cholesterol control and depression in middle-aged patients offered this treatment strategy. The intervention patients were less disabled at the end of one year, rated their quality of life as higher and were more satisfied with medical care.
Implementation is the catch here as such an approach requires a lot of steps like coordination of resources, an excellently trained nurse practitioner, a nephrologist and other specialists, etc. The TEAMcare approach is costly so the researchers are now in the process of analysing whether this actually saves the system any money.
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