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Collaborative Care for Diabetes, Heart Disease, and Depression

Pfeifer, Gail M., MA, RN

Section Editor(s): Pfeifer, Gail M. MA, RN

AJN The American Journal of Nursing: April 2011 - Volume 111 - Issue 4 - p 16
doi: 10.1097/01.NAJ.0000396544.41007.2f
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At Myrtue Medical Center in Harlan, Iowa, primary care physician Don Klitgaard and his colleagues have reorganized their small-town clinic into what they call a "medical home," where nurses, physicians, and a diabetes nurse educator are all part of the health care team. Photo by Nati Harnik / AP Photo.

Planned collaboration may seem like a no-brainer, but its use is far from typical in current health care systems. Two recent studies show that careful planning can improve patient out-comes and may serve as models that deserve wider consideration.

In the first study, by Walker and colleagues, certified diabetes nurse educators were teamed with nonclinical health educators to compare the effects of a telephone intervention with those of an active control (printed materials) on glycated hemoglobin (HbA1c) levels in 444 low-income, insured, mostly minority patients (62% black, 23% Hispanic) with type 2 diabetes. The authors found a mean decrease of 0.23% in HbA1c levels in the telephone group, compared with a mean increase of 0.13% in those without telephone follow-up. Although these results were modest, the authors found that a greater number of calls (six or more) over the one-year study period was associated with even greater improvements in HbA1c levels.

In the second study, also conducted over one year, Katon and colleagues used an integrated treat-to-target approach to managing care. Nurses, primary care physicians, psychiatrists, and psychologists collaborated to measure disease control in patients with poorly controlled diabetes, heart disease, or both; all patients also had symptoms of depression. Subjects were recruited from 14 primary care clinics in Washington State (roughly a quarter were of minority race or ethnicity). Three part-time RNs experienced in diabetes education served as communicators between the specialists and developed a maintenance plan with each patient; the nurses followed up with the patients by telephone every four weeks. Patients in the intervention group (n = 106) had better overall improvements in HbA1c levels, cholesterol levels, systolic blood pressure, and depression scores than patients in the control group receiving usual care (n = 108). Patients in the intervention group had an average of 10 in-person and 10.8 telephone visits over the study period. The mean cost per patient was $1,224.

Both studies suggest that a well-planned interdisciplinary approach to improving disease self-management can result in better patient outcomes.—Gail M. Pfeifer, MA, RN

Walker EA, et al. Diabetes Care 2011;34(1):2-7;
    Katon WJ, et al. N Engl J Med 2010;363(27):2611-20.
    © 2011 Lippincott Williams & Wilkins, Inc.