1
|
Pouwer F, Mizokami-Stout K, Reeves ND, Pop-Busui R, Tesfaye S, Boulton AJM, Vileikyte L. Psychosocial Care for People With Diabetic Neuropathy: Time for Action. Diabetes Care 2024; 47:17-25. [PMID: 38117989 DOI: 10.2337/dci23-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 12/22/2023]
Abstract
Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
Collapse
Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
- Lieutenant Colonel Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester, U.K
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Andrew J M Boulton
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| | - Loretta Vileikyte
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| |
Collapse
|
2
|
Sachar A, Breslin N, Ng SM. An integrated care model for mental health in diabetes: Recommendations for local implementation by the Diabetes and Mental Health Expert Working Group in England. Diabet Med 2023; 40:e15029. [PMID: 36537609 DOI: 10.1111/dme.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies and expert opinion from across the UK and form other long term conditions. THE CASE FOR INTEGRATION There is good the evidence around the high prevalence of co-morbidity between diabetes and mental illness of all severities and, the poorer diabetes and mental health outcomes for patients when this co-morbidity exists. Detecting and managing the mental health co-morbidity improves these outcomes, but the evidence suggests that detection of mental illness is poor in the context of diabetes care in community and acute care settings and that when it is detected, the access to appropriate mental health resource is variable and generally inadequate. THE MODEL OF INTEGRATED CARE FOR DIABETES The EWG developed a one-page Model with five core principles and five operational work-streams to support the delivery of integration, with examples of local case studies for local implementation. The five core principals are: Care for all-describing how care for all PWD needs to explore what matters to them and that emotional wellbeing is supported at diagnosis and beyond; Support and information-describing how HCPs should appropriately signpost to mental health support and the need for structured education programmes to include mental healthcare information; Needs identified-describing how PWD should have their mental health needs identified and acted on; Integrated care-describing how people with mental illness and diabetes should have their diabetes considered within their mental health care; Specialist care-describing how PWD should be able to access specialist diabetes mental health professionals. The five cross cutting work-streams for operationalising the principles are: Implementing training and upskilling of HCPs; Embedding mental health screening and assessment into diabetes pathways; Ensuring access to clear, integrated local pathways; Ensuring addressing health inequalities is incorporated at every stage of service development; Improving access to specialist mental health services through commissioning. DISCUSSION AND CONCLUSIONS The Model can be implemented in part or completely, at an individual level, all the way up to system level. It can be adapted across the life span and the UK, and having learnt from other long term conditions, there is a lot of transferability across all long term conditions There is an opportunity for ICBs to consider economies of scale across multiple long term conditions for which there will be a significant overlap of patients within the local population. Any local implementation should be in co-production with experts by experience and third sector providers.
Collapse
Affiliation(s)
- Amrit Sachar
- Liaison Psychiatry Service, Charing Cross and Hammersmith Hospitals, Imperial College Healthcare NHS Trust and West London NHS Trust, London, United Kingdom
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, United Kingdom
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
3
|
Banstola A, Pokhrel S, Hayhoe B, Nicholls D, Harris M, Anokye N. Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review. BMJ Open 2023; 13:e069270. [PMID: 36854591 PMCID: PMC9980364 DOI: 10.1136/bmjopen-2022-069270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective. DESIGN A systematic review. DATA SOURCES MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022. ELIGIBILITY CRITERIA We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted. RESULTS A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods. CONCLUSIONS Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions. PROSPERO REGISTRATION NUMBER CRD42022302036.
Collapse
Affiliation(s)
- Amrit Banstola
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Subhash Pokhrel
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Nana Anokye
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| |
Collapse
|
4
|
Bellon J, Quinlan C, Taylor B, Nemecek D, Borden E, Needs P. Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US. JAMA Netw Open 2022; 5:e2244644. [PMID: 36472875 PMCID: PMC9856223 DOI: 10.1001/jamanetworkopen.2022.44644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Outpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established. OBJECTIVE To investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021. EXPOSURES Receipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits. MAIN OUTCOMES AND MEASURES The main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders. RESULTS The study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P < .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P < .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT. CONCLUSIONS AND RELEVANCE In this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.
Collapse
Affiliation(s)
| | | | | | | | - Eva Borden
- Evernorth Health, Inc, St Louis, Missouri
| | | |
Collapse
|
5
|
Stefan S, Alzedaneen Y, Whitlatch HB, Malek R, Munir K. Effects of Electroconvulsive Therapy on Glycemic Control in Type 1 Diabetes. Cureus 2022; 14:e30222. [PMID: 36381878 PMCID: PMC9651074 DOI: 10.7759/cureus.30222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a treatment modality for refractory depression and other severe psychiatric diseases. Depression is a common comorbid condition of diabetes. Yet, evidence regarding the effect of ECT on glycemic control in patients with diabetes is limited and conflicting, with reports of both exacerbation and amelioration of hyperglycemia. A 52-year-old Caucasian man with a history of type 1 diabetes mellitus (T1DM) was admitted for ECT therapy in the setting of worsening depression refractory to medical treatment. Pre-admission glycemic control was poor. He had significant glycemic variability during his hospitalization with hyper- and hypoglycemia. He required near-daily adjustment of insulin doses and distinct “ECT day” and “non-ECT day” insulin regimens. By the conclusion of his ECT course, in addition to achieving favorable psychiatric recovery, he had a marked improvement in glycemic control. This suggests that the treatment of depression may have beneficial effects on improving glycemic control in patients with T1DM.
Collapse
|
6
|
Christensen MK, McGrath JJ, Momen N, Weye N, Agerbo E, Pedersen CB, Plana-Ripoll O, Iburg KM. The health care cost of comorbidity in individuals with mental disorders: A Danish register-based study. Aust N Z J Psychiatry 2022; 57:914-922. [PMID: 36204985 DOI: 10.1177/00048674221129184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of the study was to estimate the annual health care cost by number of comorbid mental and somatic disorders in persons with a mental disorder. METHODS All persons living in Denmark between 2004 and 2017 with a hospital diagnosis of a mental disorder were identified. We investigated the cost of different health care services: psychiatric hospitals, somatic hospitals, primary health care (e.g. general practitioners, psychologists and so on) and subsidised prescriptions. Within those with at least one mental disorder, we examined the costs for people with (a) counts of different types of mental disorders (e.g. exactly 1, exactly 2 and so on up to 8 or more) and (b) counts of different types of somatic disorders (e.g. no somatic disorders, exactly 1, exactly 2 and so on up to 15 or more). The estimates are reported in average cost per case and nationwide annual cost in Euro 2017. RESULTS In total, 447,209 persons (238,659 females and 208,550 males) were diagnosed with at least one mental disorder in the study period. The average annual health care cost per case and nationwide cost was 4471 Euros and 786 million Euro, respectively, for persons with exactly one mental disorder, and 33,273 Euro and 3.6 million Euro for persons with eight or more mental disorders. The annual health care cost was 4613 Euro per case and 386 million Euro for persons without any somatic disorders, while the cost per case was 16,344 Euro and 0.7 million Euro in nationwide cost for persons with 15 or more disorders. The amount and proportion of the different health care costs varied by type of comorbidity and count of disorders. CONCLUSIONS The annual health care cost per case was higher with increasing number of comorbid mental and somatic disorders, while the nationwide annual health care cost was lower with increasing number of comorbid disorders for persons with a mental disorder in Denmark.
Collapse
Affiliation(s)
- Maria K Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Natalie Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Nanna Weye
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Carsten Bøcker Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kim M Iburg
- Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
Collapse
Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| |
Collapse
|
8
|
Impact of Depression Onset and Treatment on the Trend of Annual Medical Costs in Japan: An Exploratory, Descriptive Analysis of Employer-Based Health Insurance Claims Data. Adv Ther 2022; 39:1553-1566. [PMID: 34729704 PMCID: PMC8989836 DOI: 10.1007/s12325-021-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION We aimed to clarify medical expenses in Japanese individuals before and after major depressive disorder (MDD) diagnosis, and to determine whether MDD treatment also reduces medical costs for comorbid physical conditions. METHODS This was an exploratory, descriptive, retrospective analysis of insurance claims data from JMDC Inc. Cohort A included individuals aged 18-64 years between January 2015 and December 2019. Cohorts B and C included Cohort A individuals with diabetes/hypertension ('chronic disease'), and sleep/anxiety disorders ('high depression risk'), respectively. Individuals in Cohorts A-C with an MDD diagnosis were analyzed by year of MDD onset (Cohorts A-CMDD2015-2019). Diagnoses and median medical costs were derived from International Classification of Diseases 10 codes. RESULTS Total medical and non-neuropsychiatric drug costs in MDD onset years were 170,390-182,120 and 8480-9586 yen higher, respectively, for Cohorts AMDD2015-2019 than for Cohort A. In Cohort AMDD2019, total medical and non-neuropsychiatric drug costs increased incrementally from 2015 to 2019 (total changes: + 165,130 and + 7365 yen, respectively), to a greater degree than in Cohort A (+ 10,510 and + 1246 yen, respectively). Neuropsychiatric drug costs increased in the year of MDD onset only and decreased thereafter. After MDD onset, decreases in total medical and non-neuropsychiatric drug costs were observed (Cohorts AMDD2015-2019). Non-neuropsychiatric drug costs also decreased after MDD onset in the chronic disease groups (Cohorts CMDD2015-2019), but not in patients with MDD recurrence. CONCLUSION Treating MDD reduces medical costs for comorbid physical conditions and may be a useful strategy for improving healthcare efficiency in Japan.
Collapse
|
9
|
Ladapo JA, Davidson KW, Moise N, Chen A, Clarke GN, Dolor RJ, Margolis KL, Thanataveerat A, Kronish IM. Economic outcomes of depression screening after acute coronary syndromes: The CODIACS-QoL randomized clinical trial. Gen Hosp Psychiatry 2021; 71:47-54. [PMID: 33933921 PMCID: PMC10784112 DOI: 10.1016/j.genhosppsych.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of screening for depression in patients with acute coronary syndrome (ACS) and no history of depression. METHODS Cost-effectiveness analysis of a randomized trial enrolling 1500 patients with ACS between 2013 and 2017. Patients were randomized to no screening, screening and notifying the primary care provider (PCP), and screening, notifying the PCP, and providing enhanced depression treatment. Outcomes measured were Healthcare utilization, costs, and incremental cost-effectiveness ratios. RESULTS 7.1% of patients screened positive for depressive symptoms. There was no significant difference in usage of mental health services, cardiovascular tests and procedures, and medications. Mean total costs in No Screen group ($7440), in Screen, Notify, and Treat group ($6745), and in Screen and Notify group ($6204). The difference was only significant in the Screen and Notify group versus the No Screen group (-$1236, 95% confidence interval -$2388 to -$96). Because mean QALYs were higher (+0.003 QALY in Screen and Notify; +0.004 QALYs in Screen, Notify, and Treat) and mean total costs were lower in both intervention groups, these interventions were cost-effective. There was substantial uncertainty because confidence intervals around cost differences were wide and QALY effects were small. CONCLUSION Depression screening strategies for patients with ACS may be modestly cost-effective.
Collapse
Affiliation(s)
- Joseph A Ladapo
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| | - Karina W Davidson
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Alexander Chen
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | | | - Rowena J Dolor
- Duke University School of Medicine, Durham, NC, United States of America
| | - Karen L Margolis
- HealthPartners Institute, Minneapolis, MN, United States of America
| | | | - Ian M Kronish
- Columbia University Irving Medical Center, New York, NY, United States of America
| |
Collapse
|
10
|
Bui LN, Yoon J, Hynes DM. A Reduction in Health Care Expenditures Linked to Mental Health Service Use Among Adults With Chronic Physical Conditions. Psychiatr Serv 2021; 72:766-775. [PMID: 33940945 DOI: 10.1176/appi.ps.202000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim was to examine the impact of receipt of mental health services on health care expenditures for U.S. adults with major chronic physical conditions. METHODS Medical Expenditure Panel Survey data for 2004-2014 were analyzed for adults ages ≥18 with at least one of six chronic physical conditions (cardiovascular diseases, cancer, diabetes, emphysema, asthma, and arthritis) who were followed up for 2 years (N=33,419). Outcomes included overall health care spending and expenditure by service type (inpatient services, outpatient services, emergency department visits, office-based physician visits, and prescribed medication). A difference-in-differences model compared a change in health care costs in the subsequent year for those who did and did not receive mental health services in the preceding year. RESULTS On average, the increase in overall health care expenditure in the subsequent year among adults receiving mental health services in the preceding year was smaller by 12.6 percentage points (p<0.05) than for those who did not receive such services. The difference was equivalent to $1,146 in 2014 constant U.S. dollars (p=0.05). Medication treatment alone did not have a meaningful effect on overall costs. The combination of psychotherapy and medication was associated with a per-capita reduction in overall health care expenditure of 21.7 percentage points, or $2,690 (p<0.01). The combination was also associated with reduced costs for office-based visits (p<0.05) and medication (p<0.05). CONCLUSIONS Receipt of mental health services was associated with a reduction in overall health care costs, particularly for office-based visits and prescribed medication, among adults with chronic physical conditions.
Collapse
Affiliation(s)
- Linh N Bui
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, and Sutter Health Center for Health Systems Research, Berkeley (Bui); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Yoon); Health Management and Policy, College of Public Health and Human Sciences, and Health Data and Informatics, Center for Genome Research and Biocomputing, Oregon State University, Corvallis, and Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs Portland Healthcare System, Portland (Hynes)
| | - Jangho Yoon
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, and Sutter Health Center for Health Systems Research, Berkeley (Bui); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Yoon); Health Management and Policy, College of Public Health and Human Sciences, and Health Data and Informatics, Center for Genome Research and Biocomputing, Oregon State University, Corvallis, and Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs Portland Healthcare System, Portland (Hynes)
| | - Denise M Hynes
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, and Sutter Health Center for Health Systems Research, Berkeley (Bui); Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Yoon); Health Management and Policy, College of Public Health and Human Sciences, and Health Data and Informatics, Center for Genome Research and Biocomputing, Oregon State University, Corvallis, and Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs Portland Healthcare System, Portland (Hynes)
| |
Collapse
|
11
|
Prevalence and Determinants of Mental Health among COPD Patients in a Population-Based Sample in Spain. J Clin Med 2021; 10:jcm10132786. [PMID: 34202915 PMCID: PMC8268632 DOI: 10.3390/jcm10132786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: To assess the prevalence of mental disorders (depression and anxiety), psychological distress, and psychiatric medications consumption among persons suffering from COPD; to compare this prevalence with non-COPD controls and to identify which variables are associated with worse mental health. (2) Methods: This is an epidemiological case-control study. The data were obtained from the Spanish National Health Survey 2017. Subjects were classified as COPD if they reported suffering from COPD and the diagnosis of this condition had been confirmed by a physician. For each case, we selected a non-COPD control matched by sex, age, and province of residence. Conditional logistic regression was used for multivariable analysis. (3) Results: The prevalence of mental disorders (33.9% vs. 17.1%; p < 0.001), psychological distress (35.4% vs. 18.2%; p < 0.001), and psychiatric medications consumption (34.1% vs. 21.9%; p < 0.001) was higher among COPD cases compared with non-COPD controls. After controlling for possible confounding variables, such as comorbid conditions and lifestyles, using multivariable regression, the probability of reporting mental disorders (OR 1.41; 95% CI 1.10–1.82).), psychological distress (OR 1.48; 95% CI 1.12–1.91), and psychiatric medications consumption (OR 1.38 95% CI 1.11–1.71) remained associated with COPD. Among COPD cases, being a woman, poor self-perceived health, more use of health services, and active smoking increased the probability of suffering from mental disorders, psychological distress, and psychiatric medication use. Stroke and chronic pain were the comorbidities more strongly associated with these mental health variables. (4) Conclusions: COPD patients have worse mental health and higher psychological distress and consume more psychiatric medications than non-COPD matched controls. Variables associated with poorer mental health included being a woman, poor self-perceived health, use of health services, and active smoking.
Collapse
|
12
|
Kuo S, Ye W, de Groot M, Saha C, Shubrook JH, Hornsby WG, Pillay Y, Mather KJ, Herman WH. Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II. Diabetes Care 2021; 44:874-882. [PMID: 33608260 PMCID: PMC7985429 DOI: 10.2337/dc20-1639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We estimated the cost-effectiveness of the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to usual care (UC) and each other. RESEARCH DESIGN AND METHODS Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the health care sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained. RESULTS From the health care sector perspective, the EXER intervention strategy saved $313 (USD) per patient and produced 0.38 more QALY (cost saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared with UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared with EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared with UC, the EXER intervention strategy saved $126 (cost saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. In comparison with EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses. CONCLUSIONS All three Program ACTIVE II interventions represented a good value for money compared with UC. The EXER+CBT intervention was highly cost-effective or cost saving compared with the CBT or EXER interventions.
Collapse
Affiliation(s)
| | - Wen Ye
- University of Michigan, Ann Arbor, MI
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN
| | - Chandan Saha
- Indiana University School of Medicine, Indianapolis, IN
| | - Jay H Shubrook
- Touro University College of Osteopathic Medicine in California, Vallejo, CA.,Heritage College of Osteopathic Medicine, Ohio University, Athens, OH
| | | | | | | | | |
Collapse
|
13
|
Obo H, Kugbey N, Atefoe E. Social support, depression, anxiety, and quality of life among persons living with type 2 diabetes: a path analysis. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/0081246320984285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Co-morbid mental health problems among persons living with type 2 diabetes have a significant influence on diabetic persons’ self-care and, ultimately, quality of life. However, the mechanisms linking the co-morbid mental health problems of type 2 diabetes patients to the decreased quality of life are not fully understood. This study examined the direct and indirect influences of co-morbid depression and anxiety on the quality of life of 115 persons living with type 2 diabetes, using a cross-sectional survey design. Frequencies and percentages were used to summarize the data, and the Pearson correlation was used to determine the bivariate association between the study variables. PROCESS Macro in SPSS was used for mediation analyses. The findings show that depression and anxiety had significant negative correlations with the quality of life of persons living with type 2 diabetes. However, only depression had a significant negative correlation with social support. On the contrary, social support significantly and positively correlated with quality of life. The mediation analysis shows that social support partially mediated the relationship between depression and quality of life after adjusting for the sex of the participants. However, social support did not have a significant mediation effect on the link between anxiety and quality of life after adjusting for the sex of the participants. The availability of social support, especially peer support, could buffer the negative emotional experiences associated with living with type 2 diabetes and improve the quality of life for persons living with this health condition.
Collapse
Affiliation(s)
- Henry Obo
- Department of Psychology, Methodist University College, Ghana
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ghana
| | - Ethel Atefoe
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ghana
| |
Collapse
|
14
|
Brettschneider C, Heddaeus D, Steinmann M, Härter M, Watzke B, König HH. Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression - a cluster-randomized trial. BMC Psychiatry 2020; 20:427. [PMID: 32859177 PMCID: PMC7456378 DOI: 10.1186/s12888-020-02829-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped care model based on the German National Clinical Practice Guideline "Unipolar Depression" has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus treatment as usual in depression. METHODS This prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D-3L as effect measure. Resource utilization was assessed by patient questionnaires. Missing values were imputed by 'multiple imputation using chained equations' based on predictive mean matching. We calculated adjusted group differences in costs and effects as well as incremental cost-effectiveness ratios. To describe the statistical and decision uncertainty cost-effectiveness acceptability curves were constructed based on net-benefit regressions with bootstrapped standard errors (1000 replications). The complete sample and subgroups based on depression severity were considered. RESULTS We found no statically significant differences in costs and effects between IG and CG. The incremental total societal costs (+€5016; 95%-CI: [-€259;€10,290) and effects (+ 0.008 QALY; 95%-CI: [- 0.030; 0.046]) were higher in the IG in comparison to the CG. Significantly higher costs were found in the IG for outpatient physician services and psychiatrist services in comparison to the CG. Significantly higher total costs and productivity losses in the IG in comparison to the CG were found in the group with severe depression. Incremental cost-effectiveness ratios for the IG in comparison to the CG were unfavourable (complete sample: €627.000/QALY gained; mild depression: dominated; moderately severe depression: €645.154/QALY gained; severe depression: €2082,714/QALY gained) and the probability of cost-effectiveness of the intervention was low, except for the group with moderate depression (ICER: dominance; 70% for willingness-to-pay threshold of €50,000/QALY gained). CONCLUSIONS We found no evidence for cost-effectiveness of the intervention in comparison to treatment as usual. TRIAL REGISTRATION NCT, NCT01731717 . Registered 22 November 2012 - Retrospectively registered.
Collapse
Affiliation(s)
- Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.
| | - Daniela Heddaeus
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Maya Steinmann
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Institute of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmühlestrasse 14, Box 16, CH-8050 Zürich, Switzerland
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251 Hamburg, Germany
| |
Collapse
|
15
|
Akena D, Okello ES, Simoni J, Wagner G. The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda. BMC Health Serv Res 2020; 20:436. [PMID: 32430046 PMCID: PMC7236139 DOI: 10.1186/s12913-020-05301-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/06/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined. METHODS We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers. RESULTS Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients. CONCLUSION Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.
Collapse
Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia S. Okello
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | |
Collapse
|
16
|
Dehesh T, Dehesh P, Shojaei S. Prevalence and Associated Factors of Anxiety and Depression Among Patients with Type 2 Diabetes in Kerman, Southern Iran. Diabetes Metab Syndr Obes 2020; 13:1509-1517. [PMID: 32440180 PMCID: PMC7211308 DOI: 10.2147/dmso.s249385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Depression and anxiety are common disorders in patients suffering from type 2 diabetes. These disorders can lead to premature morbidity, exacerbate disease complications, make patients suffer more, and increase health-care costs. As diabetes has increased worldwide recently, it is necessary to reduce the prevalence of factors that are associated with depression and anxiety in diabetes patients. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors, including metabolic components among people with type 2 diabetes. PATIENTS AND METHODS We performed a cross-sectional study in 1500 patients with type 2 diabetes in Kerman, in the southern part of Iran. The prevalence of depression and anxiety was estimated using the Beck Depression Inventory and the Hamilton Anxiety questionnaires, respectively. After calculating the proportions of depression and anxiety, univariate logistic regression was performed. Factors whose P-values were smaller than 0.2 in univariate logistic regression were included in multiple logistic regression for confounder adjustments. The analysis was performed using SPSS version 20. RESULTS The rates of depression and anxiety were 59% (95% CI: 54.48-63.12) and 62% (95% CI: 59.51-66.27), respectively. Factors found to be independently associated with anxiety were high FBS, high LDL-C, high TG, hypertension, complications, low physical activity. Factors found to be independently associated with depression were female gender, older age, high BMI, high FBS, high LDL-C, low HDL-C, high TG, high HbA1c, hypertension, and low physical activity. Complications were independently associated with anxiety but not with depression. Female gender, older age, high BMI, low HDL-C, and high HbA1c were independently associated with depression but not with anxiety. CONCLUSION Current findings demonstrated that a large proportion of patients with type 2 diabetes suffer from depression and anxiety. This study also identified factors associated with these disorders. Controlling some metabolic variables will decrease the prevalence of these disorders and improves clinical remedy and quality of life in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Tania Dehesh
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Paria Dehesh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Correspondence: Paria Dehesh Email
| | - Shahla Shojaei
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
17
|
Vassiliadou I, Tolani E, Ip L, Smith A, Papachristou Nadal I. Patient and public involvement in integrated psychosocial care. JOURNAL OF INTEGRATED CARE 2019. [DOI: 10.1108/jica-06-2019-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Recent models of care incorporate service user involvement within the development and sustainability of a quality improvement project. The purpose of this paper is to demonstrate the significance of working with patients and members of the public for the integration of psychosocial care into long-term condition (LTC) management.
Design/methodology/approach
Research shows that mental health difficulties are more prevalent in people with LTC. The three Dimensions for Long-term Conditions (3DLC) is a patient-centred multidisciplinary service which integrates psychological and social care into the usual physical care. Thematic analysis was conducted on the discussions of the two patient and public involvement workshops that were facilitated by the service. The workshops included healthcare professionals, patients with LTC and their carers.
Findings
Several themes and subthemes emerged which highlighted the importance of discussing and treating mental health in a physical health setting, the challenges that both the patients and healthcare professionals encounter and the ways in which an integrated care service may address these barriers. The findings show that there was an emphasis on patient-centeredness, accessibility of services and the need for better communication.
Practical implications
People with LTC can be empowered to better self-manage their condition, whilst having access to all types of care, physical, social and psychological. By involving service users in the implementation process of the 3DLC service, the components of an effective integrated service are delineated.
Originality/value
The service users have identified barriers and facilitators of integrating a biopsychosocial model in care pathways. This has helped the 3DLC team to further develop the model to ensure improvements in condition-specific outcomes, quality of life and healthcare utilisation.
Collapse
|
18
|
Shell LP, Newton M, Soltis-Jarrett V, Ragaisis KM, Shea JM. Quality improvement and models of behavioral healthcare integration: Position paper #2 from the International Society of Psychiatric-Mental Health Nurses. Arch Psychiatr Nurs 2019; 33:414-420. [PMID: 31280788 DOI: 10.1016/j.apnu.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022]
Abstract
This is the second article in a series written to present and address the position of the International Society of Psychiatric-Mental Health Nurses (ISPN) related to the notion of behavioral healthcare integration and the role of nurses in the 21st century. The first article addressed assumptions, definitions and roles related to the integration of behavioral healthcare. The purpose of this article is to focus on Integrated Care within the context of recent initiatives that endeavor to improve quality, safety and reduce costs in the US healthcare system also known as the "Triple Aim" (or more recently, the Quadruple Aim). This paper specifically focuses on the role of nurses and nursing practice by: (a) connecting the concept of integrated behavioral healthcare to quality improvement (QI) and the Quadruple Aim, and (b) highlighting examples of models of integration currently in use. Discussion of models of integration compares ways various models reinforce and actualize integration of behavioral health within primary care, in various special populations across the continuum of care, and in both inpatient and community settings. This paper also stresses innovative training programs offering nurses the skills for learning behavioral health integration through online modules and participation in Interprofessional Education (IPE) activities often through simulation approaches. This 2nd manuscript is consistent with the ISPN 2016 Position Paper and reinforces the necessity for all nurses to be educated on both the Quadruple Aim and behavioral health integration to improve patient care and subsequent care outcomes.
Collapse
Affiliation(s)
- Lynn P Shell
- Rutgers University School of Nursing, Newark, NJ, United States of America.
| | - Marian Newton
- Retention and Progression, Director Psychiatric Mental Health Nursing Practitioner Program, Shenandoah University, Eleanor Wade Custer School of Nursing, Winchester, VA, United States of America
| | - Victoria Soltis-Jarrett
- Carol Morde Ross Distinguished Professor of Psychiatric-Mental Health Nursing, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, United States of America
| | - Karen M Ragaisis
- Quinnipiac University School of Nursing, Hamden, CT, United States of America
| | - Joyce M Shea
- Fairfield University, Egan School of Nursing and Health Studies, Fairfield, CT, United States of America
| |
Collapse
|
19
|
Prevalence and Associated Factors of Depression among Patients with Diabetes at Jazan Province, Saudi Arabia: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2019; 2019:6160927. [PMID: 30792987 PMCID: PMC6354152 DOI: 10.1155/2019/6160927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/06/2019] [Indexed: 12/22/2022]
Abstract
Context Patients with diabetes mellitus (DM) have a poorer quality of life when compared with patients without DM. In fact, one in every five diabetic patients suffers from comorbid depression, which can lead to poor management, poor compliance with treatment, and low quality of life. Therefore, we assessed the prevalence of depression and identified its associated factors among diabetic patients at Jazan Province, KSA. Methods and Materials A cross-sectional study was conducted among 500 diabetic patients attending a diabetic center in addition to four primary healthcare centers. We used a simple Arabic translation of the Beck Depression Inventory (BDI II) tool to evaluate the depression level among the subjects. We also evaluated the frequencies of certain sociodemographic characteristics and clinical information. Moreover, we performed univariate and multivariate analyses to identify the potential risk factors using adjusted odds ratios (AORs). Results The prevalence of depression among DM patients was 20.6%. The majority of patients showed no depression (N = 285, 59.4%), one-fifth had mild depression (N = 96, 20.0%), some (N = 55, 11.4%) had moderate depression, and some had severe depression (N = 44, 9.2%). Depression was significantly more prevalent among uneducated patients (N = 27, 31.8%) (X2 = 17.627, P = 0.001) and patients with low monthly income (< 2500 SR/month) (N = 33, 22.8%) (X2 = 9.920, P = 0.019). Hypertension (AOR = 2.531, 95% CI [1.454, 4.406]) and ischemic heart diseases (AOR = 3.892, 95% CI [1.995, 7.593]) were considered as risk factors for depression among diabetic patients. Conclusions Almost one in every five patients with DM is affected by depression coexisting with cardiovascular diseases. Therefore, screening for psychological problems, proper treatment, and educating patients with diabetes about DM self-management should be routine components of DM care.
Collapse
|
20
|
Damian AJ, Gallo JJ. Models of care for populations with chronic conditions and mental/behavioral health comorbidity. Int Rev Psychiatry 2018; 30:157-169. [PMID: 30862204 DOI: 10.1080/09540261.2019.1568233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent decades have seen increased interest in the integration of mental and physical healthcare. Healthcare reform in the US has provided an opportunity for integration of evidence-based mental health programmes. Three quarters of patients with behavioural health disorders are seen in medical settings, where behavioural problems are largely unaddressed. The human and economic toll of unaddressed mental and behavioural health needs is enormous and often hidden from view, since the behavioural or mental health implications of medical conditions like heart disease and diabetes have only recently begun to be appreciated. This paper has three goals: (1) to review models of integrated services delivery, providing a framework for making sense of strategies for integration; (2) to consider some evidence for clinical outcomes when care is integrated; and (3) to highlight some factors that enhance or impede integration in practice. The review concludes with comments on where the field is going.
Collapse
Affiliation(s)
| | - Joseph J Gallo
- b Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| |
Collapse
|
21
|
Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
Collapse
Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
| |
Collapse
|
22
|
Udedi MM, Pence BW, Kauye F, Muula AS. Study protocol for evaluating the effectiveness of depression management on gylcaemic control in non-communicable diseases clinics in Malawi. BMJ Open 2018; 8:e021601. [PMID: 30327400 PMCID: PMC6194461 DOI: 10.1136/bmjopen-2018-021601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/18/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Depression is associated with negative patient outcomes for chronic diseases and likely affects consistent physical non-communicable diseases (NCDs) care management in relation to clinic attendance and medication adherence. We found no published studies on the integration of depression management in physical NCD clinics in Malawi and assessing its effects on patient and service outcomes. Therefore, the aim of this study is to evaluate the effectiveness of integrating depression screening and management in physical NCD routine care on patient and service outcomes in Malawi. We will also determine the sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) in the detection of depression in NCD clinics. METHODS AND ANALYSIS The study will have two phases. Phase I will involve the validation of the PHQ-9 screening tool for depression, using a cross-sectional study design involving 323 participants, in two specialised physical NCD clinics in one of the 28 districts of Malawi. Using a quasi-experimental study design in four districts of Malawi not involved in the phase I study, the phase II study will evaluate the effectiveness of integrating depression screening (using PHQ-9) and management (based on a specially designed toolkit). Outcomes will be measured at 3 months and 6 months among patients with comorbid diabetes (poorly controlled) and depression attending physical NCD clinics in Malawi. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Malawi, College of Medicine Research and Ethics Committee (COMREC) on 31 August 2017 (reference P.07/17/2218). The findings will be disseminated through presentations at journal clubs, senior management of the Ministry of Health, national and international conferences as well as submission to peer-reviewed publications. Policy briefs will also be created. TRIAL REGISTRATION NUMBER PACTR201807135104799.
Collapse
Affiliation(s)
- Michael Mphatso Udedi
- Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Felix Kauye
- Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Africa Center of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|
23
|
Why Early Psychological Attention for Type 2 Diabetics Could Contribute to Metabolic Control. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Type 2 Diabetes Mellitus (T2DM) is currently a public health emergency that requires inter- and multidisciplinary medical services. The principal aim of the present work was to review the basic factors related to the possible advantages of providing early psychological attention to T2DM patients as a coadjuvant for achieving adequate metabolic control.
Material and methods: A literature review was conducted to explore the interaction between stress and depression and the relation of both to the ability of T2DM patients to effectively manage their disease. Results: It was found that stress is one of the factors linked to the etiology of depression, which is a disorder with high prevalence in diabetic patients. Consequently, an inter- and multidisciplinary approach to treating diabetic patients was developed. One of the main focuses of this approach is early psychological attention, starting shortly after the initial diagnosis.
Conclusions: The ability to create consciousness among health care professionals about the importance of early psychological attention for T2DM patients under an inter- and multidisciplinary strategy could possibly improve pharmacological adherence, metabolic control, the quality of life and the life expectancy of patients, as well as save economic resources for patient families and health institutions.
Collapse
|
24
|
Fraher EP, Richman EL, Zerden LDS, Lombardi B. Social Work Student and Practitioner Roles in Integrated Care Settings. Am J Prev Med 2018; 54:S281-S289. [PMID: 29779553 DOI: 10.1016/j.amepre.2018.01.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Social workers are increasingly being deployed in integrated medical and behavioral healthcare settings but information about the roles they fill in these settings is not well understood. This study sought to identify the functions that social workers perform in integrated settings and identify where they acquired the necessary skills to perform them. METHODS Master of social work students (n=21) and their field supervisors (n=21) who were part of a Health Resources and Services Administration-funded program to train and expand the behavioral health workforce in integrated settings were asked how often they engaged in 28 functions, where they learned to perform those functions, and the degree to which their roles overlapped with others on the healthcare team. RESULTS The most frequent functions included employing cultural competency, documenting in the electronic health record, addressing patient social determinants of health, and participating in team-based care. Respondents were least likely to engage in case conferences; use Screening, Brief Intervention and Referral to Treatment; use stepped care to determine necessary level of treatment; conduct functional assessments of daily living skills; use behavioral activation; and use problem-solving therapy. A total of 80% of respondents reported that their roles occasionally, often, very often, or always overlapped with others on the healthcare team. Students reported learning the majority of skills (76%) in their Master of Social Work programs. Supervisors attributed the majority (65%) of their skill development to on-the-job training. CONCLUSIONS Study findings suggest the need to redesign education, regulatory, and payment to better support the deployment of social workers in integrated care settings. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
Collapse
Affiliation(s)
- Erin P Fraher
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Program on Health Workforce Research and Policy, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Erica Lynn Richman
- Program on Health Workforce Research and Policy, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brianna Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
25
|
The Burden of Poor Mental Well-being Among Patients With Type 2 Diabetes Mellitus: Examining Health Care Resource Use and Work Productivity Loss. J Occup Environ Med 2018; 58:1121-1126. [PMID: 27820762 PMCID: PMC5084642 DOI: 10.1097/jom.0000000000000874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: The aim of this study was to evaluate the association of mental well-being with outcomes among patients with type 2 diabetes mellitus (T2DM). Methods: Seven thousand eight hundred fifty-two adults with T2DM were identified from a national, Internet-based study. Mental well-being [SF-36v2 mental component summary (MCS)] was categorized as good (MCS ≥ 50), poor (40 ≤ MCS < 50), and very poor (MCS < 40). Outcomes included past 6 months of health care resource use and lost productivity (Work Productivity and Activity Impairment questionnaire). Results: Respondents with very poor/poor versus good mental well-being were more likely to visit the emergency room (27%/18% vs 11%, P < 0.001) or be hospitalized (19%/14% vs 9%, P < 0.001). Among labor force participants, those with very poor/poor versus good mental well-being experienced greater overall work impairment (43.7/26.0 vs 10.7, P < 0.001). Conclusions: Greater resource use and work productivity impairment associated with poorer mental well-being among patients with T2DM has cost implications.
Collapse
|
26
|
Grochtdreis T, Zimmermann T, Puschmann E, Porzelt S, Dams J, Scherer M, König HH. Cost-utility of collaborative nurse-led self-management support for primary care patients with anxiety, depressive or somatic symptoms: A cluster-randomized controlled trial (the SMADS trial). Int J Nurs Stud 2018; 80:67-75. [DOI: 10.1016/j.ijnurstu.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/18/2017] [Accepted: 12/23/2017] [Indexed: 01/18/2023]
|
27
|
Molife C. Is Depression a Modifiable Risk Factor for Diabetes Burden? J Prim Care Community Health 2018; 1:55-61. [DOI: 10.1177/2150131909359633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this review article was to examine the empirical evidence supporting depression as a risk factor for diabetes complications and associated burden. A database search using keywords located recent clinical and population studies addressing the association between depression and type 2 diabetes. Both cross-sectional and cohort studies were reviewed. Depression appears to exacerbate the progression of type 2 diabetes. The evidence is strong supporting the hypothesis that depression in persons with diabetes increases the risk of diabetes-related burden, including suboptimal glycemic control, complications, functionality, mortality, and health care utilization. Screening for depression among patients with diabetes should be increased in primary care. Newer approaches to diabetes care management may help to slow the progression of diabetes.
Collapse
Affiliation(s)
- Cliff Molife
- Walden University, College of Health Sciences, Baltimore, MD, USA
| |
Collapse
|
28
|
Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
Collapse
Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
| |
Collapse
|
29
|
Strauss SM, Rosedale MT, Rindskopf DM. Predictors of Depression Among Adult Women With Diabetes in the United States: An Analysis Using National Health and Nutrition Examination Survey Data From 2007 to 2012. DIABETES EDUCATOR 2017; 42:728-738. [PMID: 27831524 DOI: 10.1177/0145721716672339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes. METHODS Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946). RESULTS When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes. CONCLUSION When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.
Collapse
Affiliation(s)
- Shiela M Strauss
- New York University, Rory Meyers College of Nursing, New York, New York (Dr Strauss, Dr Rosedale)
| | - Mary T Rosedale
- New York University, Rory Meyers College of Nursing, New York, New York (Dr Strauss, Dr Rosedale)
| | - David M Rindskopf
- City University of New York, Graduate School and University Center, New York, New York (Dr Rindskopf)
| |
Collapse
|
30
|
Depression and anxiety disorders in people with diabetes. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.
Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals
Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.
Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.
Collapse
|
31
|
Is Cognitive Behavioural Therapy focusing on Depression and Anxiety Effective for People with Long-Term Physical Health Conditions? A Controlled Trial in the Context of Type 2 Diabetes Mellitus. Behav Cogn Psychother 2017; 46:129-147. [DOI: 10.1017/s1352465817000492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control.
Collapse
|
32
|
Doherty AM, Gayle C, Morgan-Jones R, Archer N, Laura-Lee, Ismail K, Werner A. Improving quality of diabetes care by integrating psychological and social care for poorly controlled diabetes: 3 Dimensions of Care for Diabetes. Int J Psychiatry Med 2017; 51:3-15. [PMID: 26681232 DOI: 10.1177/0091217415621040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. METHODS The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. CONCLUSION At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities.
Collapse
Affiliation(s)
| | | | | | - Nicola Archer
- Community Neurology Service, East London NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
33
|
Shin N, Hill-Briggs F, Langan S, Payne JL, Lyketsos C, Golden SH. The association of minor and major depression with health problem-solving and diabetes self-care activities in a clinic-based population of adults with type 2 diabetes mellitus. J Diabetes Complications 2017; 31:880-885. [PMID: 28256399 PMCID: PMC7014955 DOI: 10.1016/j.jdiacomp.2017.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
AIMS We examined whether problem-solving and diabetes self-management behaviors differ by depression diagnosis - major depressive disorder (MDD) and minor depressive disorder (MinDD) - in adults with Type 2 diabetes (T2DM). METHODS We screened a clinical sample of 702 adults with T2DM for depression, identified 52 positive and a sample of 51 negative individuals, and performed a structured diagnostic psychiatric interview. MDD (n=24), MinDD (n=17), and no depression (n=62) were diagnosed using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria. Health Problem-Solving Scale (HPSS) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaires determined problem-solving and T2DM self-management skills, respectively. We compared HPSS and SDSCA scores by depression diagnosis, adjusting for age, sex, race, and diabetes duration, using linear regression. RESULTS Total HPSS scores for MDD (β=-4.38; p<0.001) and MinDD (β=-2.77; p<0.01) were lower than no depression. Total SDSCA score for MDD (β=-10.1; p<0.01) was lower than for no depression, and was partially explained by total HPSS. CONCLUSION MinDD and MDD individuals with T2DM have impaired problem-solving ability. MDD individuals had impaired diabetes self-management, partially explained by impaired problem-solving. Future studies should assess problem-solving therapy to treat T2DM and MinDD and integrated problem-solving with diabetes self-management for those with T2DM and MDD.
Collapse
MESH Headings
- Academic Medical Centers
- Aged
- Baltimore/epidemiology
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/psychology
- Cost of Illness
- Depression/complications
- Depression/epidemiology
- Depression/physiopathology
- Depression/psychology
- Depressive Disorder, Major/complications
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/physiopathology
- Depressive Disorder, Major/psychology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Diagnostic and Statistical Manual of Mental Disorders
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Male
- Middle Aged
- Outpatient Clinics, Hospital
- Patient Compliance
- Prevalence
- Problem Solving
- Self Report
- Self-Management/psychology
- Specific Learning Disorder/complications
- Specific Learning Disorder/etiology
- Specific Learning Disorder/psychology
- Stress, Psychological/etiology
- Stress, Psychological/physiopathology
- Stress, Psychological/psychology
Collapse
Affiliation(s)
- Na Shin
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Susan Langan
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jennifer L Payne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
| |
Collapse
|
34
|
The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation. BMC Health Serv Res 2017; 17:78. [PMID: 28118838 PMCID: PMC5259945 DOI: 10.1186/s12913-017-2003-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both. METHODS A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches. RESULTS Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY. CONCLUSIONS Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.
Collapse
|
35
|
Goorden M, van der Feltz-Cornelis CM, van Steenbergen-Weijenburg KM, Horn EK, Beekman AT, Hakkaart-van Roijen L. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM). Neuropsychiatr Dis Treat 2017; 13:1881-1893. [PMID: 28765710 PMCID: PMC5525903 DOI: 10.2147/ndt.s134008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Major depressive disorder (MDD) is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC) may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective. PATIENTS AND METHODS In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU) group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up. RESULTS The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680) compared to €4,582 (95% CI: 2,782 to 6,740) in the CAU group. The average quality-adjusted life years (QALYs) gained were 0.07 higher in the CC group, indicating that CC is more costly but also more effective than CAU. From a societal perspective, the incremental cost-effectiveness ratio was €24,690/QALY. CONCLUSION This first cost-utility analysis in chronically ill patients with comorbid MDD shows that CC may be a cost-effective treatment depending on willingness-to-pay levels. Nevertheless, the low utility scores emphasize the need for further research to improve the cost-effectiveness of CC in this highly prevalent and costly group of patients.
Collapse
Affiliation(s)
- Maartje Goorden
- Institute of Health Policy and Management (iBMG)/Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam
| | | | | | - Eva K Horn
- Viersprong Institute for Studies on Personality Disorders, Halsteren
| | - Aartjan Tf Beekman
- Department of Psychiatry.,EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands
| | - Leona Hakkaart-van Roijen
- Institute of Health Policy and Management (iBMG)/Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam
| |
Collapse
|
36
|
AlBekairy A, AbuRuz S, Alsabani B, Alshehri A, Aldebasi T, Alkatheri A, Almodaimegh H. Exploring Factors Associated with Depression and Anxiety among Hospitalized Patients with Type 2 Diabetes Mellitus. Med Princ Pract 2017; 26:547-553. [PMID: 29131123 PMCID: PMC5848470 DOI: 10.1159/000484929] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aims of the current study were to determine the prevalence and severity of anxiety and depression, and to explore associated factors among hospitalized patients with type 2 diabetes mellitus. SUBJECTS AND METHODS All patients with type 2 diabetes (160 patients) who were admitted to the Internal Medicine Wards of the King Abdulaziz Medical City, Riyadh, Saudi Arabia, from January to August 2015 were asked to participate, and 158 patients agreed to do so. A self-administered questionnaire consisting of 2 parts was used. The first part was on sociodemographic information, and the second part was a validated screening tool for assessing depression and anxiety. The severity of anxiety and depression was classified as normal, mild, moderate, and severe. Logistic regression was carried out to identify variables that were independently associated with anxiety and depression. RESULTS Using the screening tool, 85 (53.8%) and 80 (50.6%) study patients were identified as patients who suffered from depression and anxiety, respectively. The severity of distress was moderate/severe in 36 (42.4%) patients with depression and 41 (51.3%) patients with anxiety. The factors independently associated with the risk for anxiety in hospitalized patients with diabetes were physical inactivity and staying 8 days or longer in the hospital. On the other hand, factors that were independently associated with the risk for depression were older age, low income, and nephropathy. CONCLUSION The majority of hospitalized patients with diabetes developed moderate/severe anxiety or depression, or both, during hospitalization. Hence, screening for anxiety and depression in high-risk hospitalized diabetic patients is recommended during hospitalization.
Collapse
Affiliation(s)
- Abdulkareem AlBekairy
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Salah AbuRuz
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
- College of Pharmacy, University of Jordan, Amman, Jordan
- *Salah AbuRuz, College of Pharmacy, Al Ain University of Science and Technology, Albaladya Street, 124th Street, PO Box 64141, Al Ain (United Arab Emirates), E-Mail
| | - Bandar Alsabani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshehri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tariq Aldebasi
- Division of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmalik Alkatheri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
37
|
Lam CA, Sherbourne C, Gelberg L, Lee ML, Huynh AK, Chu K, Strauss JL, Metzger ME, Post EP, Rubenstein LV, Farmer MM. Differences in Depression Care for Men and Women among Veterans with and without Psychiatric Comorbidities. Womens Health Issues 2016; 27:206-213. [PMID: 28007391 DOI: 10.1016/j.whi.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is common among primary care patients, affecting more women than men. Women veterans are an extreme but growing minority among patients seeking care from the Department of Veterans Affairs (VA), an organization historically designed to serve men. Little is known about gender differences in depression care quality within the VA primary care population. PURPOSE This works assesses the gender differences in depression care among veterans using longitudinal electronic measures. METHODS We undertook a cross-sectional study of all veteran VA primary care users with a new episode of depression from federal fiscal year 2010, covering nine geographically diverse regions. We assessed the quality of depression care based on receipt of minimally appropriate depression treatment within 1 year of a new episode of depression and on receipt of depression-related follow-up visits within 180 days. Minimally appropriate treatment and follow-up were operationalized as meeting or exceeding a minimally appropriate threshold for care, based on national quality measures and expert panel consensus. Regression models were used to produce predicted probabilities for each process outcome accounting for the presence or absence of other psychiatric comorbidities. All models were adjusted for model covariates and clinic clusters (404 sites). MAIN FINDINGS In 2010, 110,603 veterans with a primary care visit had a new episode of depression; 10,094 (9%) were women. In multivariate analyses, women had modest yet significantly higher rates of minimally appropriate depression treatment than men, whether patients had depression only (79% of women vs. 76% of men; p < .001) or depression along with other psychiatric comorbidities (92% of women vs. 91% or men; p < .001). There were no significant gender differences for rate of receipt of follow-up for depression at 180 days. Interactions between gender and other psychiatric comorbidities were not significant. CONCLUSIONS Our findings suggest that the VA is achieving comparable depression care between genders at minimally appropriate thresholds.
Collapse
Affiliation(s)
- Christine A Lam
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California.
| | | | - Lillian Gelberg
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martin L Lee
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Alexis K Huynh
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Karen Chu
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Jennifer L Strauss
- Mental Health Services, Department of Veterans Affairs, Washington, DC; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina
| | - Maureen E Metzger
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan
| | - Edward P Post
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Lisa V Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; RAND Corporation, Santa Monica, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Melissa M Farmer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California
| |
Collapse
|
38
|
Fisher EB, Thorpe CT, McEvoy DeVellis B, DeVellis RF. Healthy Coping, Negative Emotions, and Diabetes Management. DIABETES EDUCATOR 2016; 33:1080-103; discussion 1104-6. [DOI: 10.1177/0145721707309808] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edwin B. Fisher
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill,
| | - Carolyn T. Thorpe
- Center for Health Services Research in Primary Care,
Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Brenda McEvoy DeVellis
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill
| | - Robert F. DeVellis
- Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
39
|
Jansen F, Krebber AMH, Coupé VMH, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout GM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Cost-Utility of Stepped Care Targeting Psychological Distress in Patients With Head and Neck or Lung Cancer. J Clin Oncol 2016; 35:314-324. [PMID: 27918712 DOI: 10.1200/jco.2016.68.8739] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose A stepped care (SC) program in which an effective yet least resource-intensive treatment is delivered to patients first and followed, when necessary, by more resource-intensive treatments was found to be effective in improving distress levels of patients with head and neck cancer or lung cancer. Information on the value of this program for its cost is now called for. Therefore, this study aimed to assess the cost-utility of the SC program compared with care-as-usual (CAU) in patients with head and neck cancer or lung cancer who have psychological distress. Patients and Methods In total, 156 patients were randomly assigned to SC or CAU. Intervention costs, direct medical costs, direct nonmedical costs, productivity losses, and health-related quality-of-life data during the intervention or control period and 12 months of follow-up were calculated by using Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry, Productivity and Disease Questionnaire, and EuroQol-5 Dimension measures and data from the hospital information system. The SC program's value for the cost was investigated by comparing mean cumulative costs and quality-adjusted life years (QALYs). Results After imputation of missing data, mean cumulative costs were -€3,950 (95% CI, -€8,158 to -€190) lower, and mean number of QALYs was 0.116 (95% CI, 0.005 to 0.227) higher in the intervention group compared with the control group. The intervention group had a probability of 96% that cumulative QALYs were higher and cumulative costs were lower than in the control group. Four additional analyses were conducted to assess the robustness of this finding, and they found that the intervention group had a probability of 84% to 98% that cumulative QALYs were higher and a probability of 91% to 99% that costs were lower than in the control group. Conclusion SC is highly likely to be cost-effective; the number of QALYs was higher and cumulative costs were lower for SC compared with CAU.
Collapse
Affiliation(s)
- Femke Jansen
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Anna M H Krebber
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Veerle M H Coupé
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Pim Cuijpers
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Remco de Bree
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Annemarie Becker-Commissaris
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Egbert F Smit
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Annemieke van Straten
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Guus M Eeckhout
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Aartjan T F Beekman
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - C René Leemans
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| | - Irma M Verdonck-de Leeuw
- Femke Jansen, Anna M.H. Krebber, Veerle M.H. Coupé, Annemarie Becker-Commissaris, Egbert F. Smit, Guus M. Eeckhout, Aartjan T.F. Beekman, C. René Leemans, and Irma M. Verdonck-de Leeuw, VU Medical Center; Pim Cuijpers, Annemieke van Straten, and Irma M. Verdonck-de Leeuw, Vrije Universiteit Amsterdam, Amsterdam; and Remco de Bree, University Medical Center Utrecht Cancer Center, Utrecht, Netherlands
| |
Collapse
|
40
|
Gåfvels C, Hägerström M, Rane K, Wajngot A, Wändell PE. Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis. Health Psychol Open 2016; 3:2055102916678107. [PMID: 28070410 PMCID: PMC5193320 DOI: 10.1177/2055102916678107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.
Collapse
Affiliation(s)
- Catharina Gåfvels
- Karolinska University Hospital, Sweden; Karolinska Institutet, Sweden
| | | | | | | | | |
Collapse
|
41
|
Bhattacharya R, Shen C, Wachholtz AB, Dwibedi N, Sambamoorthi U. Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression. BMC Psychiatry 2016; 16:247. [PMID: 27431801 PMCID: PMC4950075 DOI: 10.1186/s12888-016-0964-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. METHODS We used multi-state Medicaid data (2000-2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. RESULTS Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. CONCLUSIONS Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.
Collapse
Affiliation(s)
| | - Chan Shen
- />Department of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX USA
- />Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1444, Houston, TX 77030 USA
| | - Amy B. Wachholtz
- />Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA USA
| | - Nilanjana Dwibedi
- />Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV USA
| | - Usha Sambamoorthi
- />Department of Social & Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV USA
| |
Collapse
|
42
|
Bickett A, Tapp H. Anxiety and diabetes: Innovative approaches to management in primary care. Exp Biol Med (Maywood) 2016; 241:1724-31. [PMID: 27390262 DOI: 10.1177/1535370216657613] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.
Collapse
Affiliation(s)
- Allison Bickett
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| |
Collapse
|
43
|
Fonda SJ, Graham C, Munakata J, Powers JM, Price D, Vigersky RA. The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes. J Diabetes Sci Technol 2016; 10:898-904. [PMID: 26843480 PMCID: PMC4928220 DOI: 10.1177/1932296816628547] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This analysis models the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) using evidence from a randomized controlled trial (RCT) that demonstrated RT-CGM reduced A1C, for up to 9 months after using the technology, among patients with type 2 diabetes not on prandial insulin. RT-CGM was offered short-term and intermittently as a self-care tool to inform patients' behavior. METHOD The analyses projected lifetime clinical and economic outcomes for RT-CGM versus self-monitoring of blood glucose by fingerstick only. The base-case analysis was consistent with the RCT (RT-CGM for 2 weeks on/1 week off over 3 months). A scenario analysis simulated outcomes of an RT-CGM "refresher" after the active intervention of the RCT. Analyses used the IMS CORE Diabetes Model and were conducted from a US third-party payer perspective, including direct costs obtained from published sources and inflated to 2011 US dollars. Costs and health outcomes were discounted at 3% per annum. RESULTS Life expectancy (LE) and quality-adjusted life expectancy (QALE) from RT-CGM were 0.10 and 0.07, with a cost of $653/patient over a lifetime. Incremental LE and QALE from a "refresher" were 0.14 and 0.10, with a cost of $1312/patient over a lifetime, and incremental cost-effectiveness ratios were $9319 and $13 030 per LY and QALY gained. CONCLUSIONS RT-CGM, as a self-care tool, is a cost-effective disease management option in the US for people with type 2 diabetes not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effectiveness.
Collapse
|
44
|
Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011. J Gen Intern Med 2016; 31:615-22. [PMID: 26969312 PMCID: PMC4870425 DOI: 10.1007/s11606-016-3650-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate differences in healthcare cost trends over 8 years in adults with diabetes and one of four categories of comorbid depression: no depression, unrecognized depression, asymptomatic depression, or symptomatic depression. RESEARCH DESIGN AND METHODS Data from the 2004-2011 Medical Expenditure Panel Survey (MEPS) was used to create nationally representative estimates. The dependent variable was total healthcare expenditures for the calendar year, including office-based, hospital outpatient, emergency room, inpatient hospital, prescription, dental, and home health care expenditures. The 2004-2011 direct medical costs were adjusted to a common 2014 dollar value. The primary independent variable was four mutually exclusive depression categories created from ICD-9-CM codes and the PHQ-2 depression screening tool. Healthcare expenditures were estimated using a two-part model and were adjusted for age, sex, race, marital status, education, health insurance, metropolitan statistical area status, region, income level, and comorbidities. RESULTS Based on a national sample of adults with diabetes (unweighted sample of 15,548, weighted sample of 17,465,579), 10.2 % had unrecognized depression, 13.6 % had asymptomatic depression, and 8.9 % had symptomatic depression. In the pooled sample, after adjusting for covariates, the incremental cost of unrecognized depression was $2872 (95 % CI 1660-4084), asymptomatic depression increased by $3347 (95 % CI 2568-4386), and symptomatic depression increased by $5170 (CI 95 % 3610-6731) compared to patients with no depression. CONCLUSIONS Adjusted analyses showed that expenditures were $2000-3000 higher for unrecognized and asymptomatic depression than no depression, and $5000 higher for symptomatic depression. Higher medical expenditures persisted over time, with only symptomatic depression showing a sustained decrease over time.
Collapse
|
45
|
McBain H, Mulligan K, Haddad M, Flood C, Jones J, Simpson A. Self management interventions for type 2 diabetes in adult people with severe mental illness. Cochrane Database Syst Rev 2016; 4:CD011361. [PMID: 27120555 PMCID: PMC10201333 DOI: 10.1002/14651858.cd011361.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with severe mental illness are twice as likely to develop type 2 diabetes as those without severe mental illness. Treatment guidelines for type 2 diabetes recommend that structured education should be integrated into routine care and should be offered to all. However, for people with severe mental illness, physical health may be a low priority, and motivation to change may be limited. These additional challenges mean that the findings reported in previous systematic reviews of diabetes self management interventions may not be generalised to those with severe mental illness, and that tailored approaches to effective diabetes education may be required for this population. OBJECTIVES To assess the effects of diabetes self management interventions specifically tailored for people with type 2 diabetes and severe mental illness. SEARCH METHODS We searched the Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the International Clinical Trials Registry Platform (ICTRP) Search Portal, ClinicalTrials.gov and grey literature. The date of the last search of all databases was 07 March 2016. SELECTION CRITERIA Randomised controlled trials of diabetes self management interventions for people with type 2 diabetes and severe mental illness. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles, extracted data and conducted the risk of bias assessment. We used a taxonomy of behaviour change techniques and the framework for behaviour change theory to describe the theoretical basis of the interventions and active ingredients. We used the GRADE method (Grades of Recommendation, Assessment, Development and Evaluation Working Group) to assess trials for overall quality of evidence. MAIN RESULTS We included one randomised controlled trial involving 64 participants with schizophrenia or schizoaffective disorder. The average age of participants was 54 years; participants had been living with type 2 diabetes for on average nine years, and with their psychiatric diagnosis since they were on average 28 years of age. Investigators evaluated the 24-week Diabetes Awareness and Rehabilitation Training (DART) programme in comparison with usual care plus information (UCI). Follow-up after trial completion was six months. Risk of bias was mostly unclear but was high for selective reporting. Trial authors did not report on diabetes-related complications, all-cause mortality, adverse events, health-related quality of life nor socioeconomic effects. Twelve months of data on self care behaviours as measured by total energy expenditure showed a mean of 2148 kcal for DART and 1496 kcal for UCI (52 participants; very low-quality evidence), indicating no substantial improvement. The intervention did not have a substantial effect on glycosylated haemoglobin A1c (HbA1c) at 6 or 12 months of follow-up (12-month HbA1c data 7.9% for DART vs 6.9% for UCI; 52 participants; very low-quality evidence). Researchers noted small improvements in body mass index immediately after the intervention was provided and at six months, along with improved weight post intervention. Diabetes knowledge and self efficacy improved immediately following receipt of the intervention, and knowledge also at six months. The intervention did not improve blood pressure. AUTHORS' CONCLUSIONS Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes. Researchers must conduct additional trials to establish efficacy, and to identify the active ingredients in these interventions and the people most likely to benefit from them.
Collapse
Affiliation(s)
- Hayley McBain
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Kathleen Mulligan
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Mark Haddad
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Chris Flood
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Julia Jones
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Alan Simpson
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | | |
Collapse
|
46
|
Padwa H, Teruya C, Tran E, Lovinger K, Antonini VP, Overholt C, Urada D. The Implementation of Integrated Behavioral Health Protocols In Primary Care Settings in Project Care. J Subst Abuse Treat 2016; 62:74-83. [DOI: 10.1016/j.jsat.2015.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022]
|
47
|
Guthrie EA, Dickens C, Blakemore A, Watson J, Chew-Graham C, Lovell K, Afzal C, Kapur N, Tomenson B. Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness. J Psychosom Res 2016; 82:54-61. [PMID: 26919799 PMCID: PMC4796037 DOI: 10.1016/j.jpsychores.2014.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/12/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. METHOD 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. RESULTS The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86). CONCLUSION To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission.
Collapse
Affiliation(s)
- Elspeth A Guthrie
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Chris Dickens
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK; Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, UK.
| | - Amy Blakemore
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK; National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Jennifer Watson
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, UK.
| | - Cara Afzal
- Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
| | - Navneet Kapur
- Centre for Suicide Prevention, University Place, The University of Manchester, Oxford Road, Manchester, UK.
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK.
| |
Collapse
|
48
|
Wright DR, Katon WJ, Ludman E, McCauley E, Oliver M, Lindenbaum J, Richardson LP. Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures. Acad Pediatr 2016; 16:82-9. [PMID: 26456002 PMCID: PMC4715622 DOI: 10.1016/j.acap.2015.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 07/18/2015] [Accepted: 08/29/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective. METHODS We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank sum, and t tests were used to test for statistical differences in outcomes between adolescents on the basis of screening status. RESULTS Of the 4010 adolescents who completed depression screening, 3707 (92.4%) screened negative (PHQ-2 <2 or PHQ-9 <10), 186 (3.9%) screened positive for mild depression (PHQ-9 10-14), and 95 (2.4%) screened positive for moderate to severe depression (PHQ-9 ≥15). In the 12 months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and they had significantly higher utilization of outpatient medical (mean ± SD, 8.3 ± 1.5 vs 3.5 ± 5.1) and mental health (3.8 ± 9.3 vs 0.7 ± 3.5) visits. Total health care system costs for screen-positive adolescents ($5083 ± $10,489) were more than twice as high as those of screen-negative adolescents ($2357 ± $7621). CONCLUSIONS Adolescent depressive symptoms, even when mild, are associated with increased health care utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control health care costs among screen-positive adolescents.
Collapse
Affiliation(s)
- Davene R. Wright
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145
| | - Wayne J. Katon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA. Address: Box 356560, Seattle, WA 98195-6560
| | - Evette Ludman
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Elizabeth McCauley
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA. Address: Box 356560, Seattle, WA 98195-6560
| | - Malia Oliver
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Jeffrey Lindenbaum
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Laura P. Richardson
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145
| |
Collapse
|
49
|
Lee S, Rothbard A, Choi S. Effects of comorbid health conditions on healthcare expenditures among people with severe mental illness. J Ment Health 2015; 25:291-296. [PMID: 26654582 DOI: 10.3109/09638237.2015.1101420] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS Little is known about the incremental cost burden associated with treating comorbid health conditions among people with severe mental illness (SMI). This study compares the extent to which each individual medical condition increases healthcare expenditures between people with SMI and people without mental illness. METHODS Data were obtained from the 2011 Medical Expenditure Panel Survey (MEPS; N = 17 764). Mental illness and physical health conditions were identified through ICD-9 codes. Guided by the Andersen's behavioral model of health services utilization, generalized linear models were conducted. RESULTS Total healthcare expenditures among individuals with SMI were approximately 3.3 times greater than expenditures by individuals without mental illness ($11 399 vs. $3449, respectively). Each additional physical health condition increased the total healthcare expenditure by 17.4% for individuals with SMI compared to the 44.8% increase for individuals without mental illness. CONCLUSIONS The cost effect of having additional health conditions on the total healthcare expenditures among individuals with SMI is smaller than those individuals without mental illness. Whether this is due to limited access to healthcare for the medical problems or better coordination between medical and mental health providers, which reduces duplicated medical procedures or visits, requires future investigation.
Collapse
Affiliation(s)
- Sungkyu Lee
- a School of Social Welfare, Soongsil University , Seoul , Korea
| | - Aileen Rothbard
- b Center for Mental Health Policy & Services Research, University of Pennsylvania , Pennsylvania , PA , USA , and
| | - Sunha Choi
- c College of Social Work, The University of Tennessee at Knoxville , TN , USA
| |
Collapse
|
50
|
Doherty AM, Gayle C, Ismail K. 3 Dimensions of Care for Diabetes: integrating diabetes care into an individual's world. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- AM Doherty
- 3 Dimensions of Care for Diabetes; King's College Hospital NHS Foundation Trust; London UK
| | - C Gayle
- King's College Hospital NHS Foundation Trust; London UK
| | - K Ismail
- King's College London, and Consultant Liaison Psychiatrist; King's College Hospital NHS Foundation Trust; London UK
| |
Collapse
|