Collaborative Intervention May Trump Usual Care

Patients with chronic disease, depression benefit from guideline-based care by nurse

WEDNESDAY, Dec. 29 (HealthDay News) -- Collaborative, coordinated management, in which a supervised nurse works in tandem with a patient's primary care physician to provide guideline-based care, appears to result in better disease and depression control and management in patients than usual care, according to research published in the Dec. 30 issue of the New England Journal of Medicine.

Wayne J. Katon, M.D., of the University of Washington School of Medicine in Seattle, and colleagues randomly assigned 214 patients with poorly controlled diabetes and/or coronary heart disease and coexisting depression to collaborative intervention or usual care. In the intervention, a medically supervised nurse worked with each patient's primary care physician to provide collaborative care, guideline-based management with the aim of controlling risk factors.

Compared with controls, the researchers found that the patients in the collaborative intervention group saw greater 12-month improvement in glycated hemoglobin levels, low-density lipoprotein cholesterol, systolic blood pressure, and depression scores. These patients were also more likely to have adjustments made to their insulin, hypertension, and depression medications and to report better quality of life and greater satisfaction with care for their physical and mental health.

"Patients in the intervention group were more satisfied than controls with the care that they received for medical and psychological disorders. Satisfaction with care predicts enhanced self-care and more favorable outcomes. The intervention may have improved patient outcomes and satisfaction by systematically supporting both patients and the primary care team," the authors write.

Authors disclosed financial relationships with pharmaceutical companies; one author disclosed financial support from Group Health Cooperative, which provided support for the study.

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