Primary care patient and provider preferences for diabetes care managers

Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4%) patient responders and 28 (66%) provider responders. The majority of patients (>70%) and providers (89%) expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes car

Collaborative Care Management for Depression

The collaborative care management (CCM) model has been demonstrated to be significantly more effective compared to usual care (UC) in depression management although an initial increase in cost measures was seen. In this paper, cost measures as well as clinical response were analyzed on patients with available follow-up data at six months. Records of 219 patients with follow-up data in CCM group and 119 in UC group were reviewed. At six months, there was a statistically significant clinical response rate among patients in CCM compared to UC group ( P < 0.0001). Likewise, 65% in CCM group was “symptom-free” at 6 months vs. 31.9% in UC group ( P < 0.0001). Among the responders in both groups, there was no statistical difference in cost measures. However, cost measures were significantly higher among non-responders compared to responders within CCM. Between the two models, the non-responders in UC had lower cost measures than the non-responders under CCM

Patient Body Mass Index Does Not Predict Six-Month Clinical Outcome of Depression Managed Under Collaborative Care

Obesity and depression are often comorbid conditions. There appears to be a bidirectional relationship between these. Obesity at baseline has been shown to increase the risk of onset of depression and depression at baseline increased the odds for developing obesity. Less is understood about the impact of obesity on depression treatment outcomes. The authors’ hypothesis was that obesity (body mass index [BMI] ≥30 kg/m 2 ) and morbid obesity (BMI ≥ 40 kg/m 2 ) would each have negative effects on depression remission rates after 6 months of enrollment into collaborative care management for depression. In a retrospective analysis of 1111 depressed patients with a PHQ-9 (Patient Health Questionnaire) score of 10 or greater, multivariate analysis for the odds ratio of achieving remission at 6 months demonstrated that the patient’s BMI at baseline was not an independent risk factor for depression outcome at 6 months. Collaborative care management for depression has been shown to be effective for improving depression outcomes, yet minimal prior research has focused on other clinical comorbidities that might affect outcomes. Although obesity was common in the study population, it was reassuring, based on this study that 6-month depression treatment outcomes do not appear to be significantly affected by the patient’s baseline BMI

Increased Anxiety and Length of Treatment Associated With Depressed Patients Who are Readmitted to Collaborative Care

In 2008, the Institute for Clinical Systems Improvement (ICSI) in Minnesota implemented a model of collaborative care management (CCM) for treatment of depression in primary care. This resulted in significant improvements on both clinical response and remission over usual care, although an increase in utilization metrics has been observed. Mental health comorbidities have previously been significantly associated with an increased likelihood of not responding to initial treatment. This retrospective study hypothesized that patients with mental health comorbidities are more likely to be associated with patients who were readmitted into CCM with recurrent depression. A total of 145 patients who had completed CCM were studied; of these, 32 were diagnosed with recurrent depression and were readmitted to CCM, and 113 were in remission for at least 4 months. There were no statistically significant demographic differences between the 2 groups. The initial screening GAD-7 score for anxiety was significantly increased in the readmission group (12.81 vs 9.20, P = .001) as was the average length of treatment from initial diagnosis to remission (168.09 vs 120.99 days, P = .002). All other initial screening tests were not different between the groups. When controlling for the independent variables by multiple logistic regression, the odds ratio for GAD-7 was 1.1156 (CI = 1.0.192 to 1.2212, P = .0177) and for days of treatment in CCM was 1.0123 (CI = 1.0041 to 1.0206, P = .0033). Patients who are readmitted to CCM for recurrent depression have a statistically increased risk of associated anxiety and a longer treatment course than those who have remained in remission for at least 4 months

Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients’ Experience and Perceptions to Participation

Background: Health and Wellness Coaching has been shown to enhance treatment outcomes in the primary care setting. However, little is known about the experience and perceptions of patients who worked with a wellness coach as an integrated member of their primary health-care team. Objective: This project assessed patients’ experience and obtained their perceptions on barriers and facilitators to participation in a primary care–based wellness coaching program. Method: A survey was mailed to 99 primary care patients with prediabetes who participated in a 12-week wellness coaching program. Results: Sixty-two (63%) completed the survey; responders felt that participation in the wellness coaching program helped move them toward healthier lifestyle behavior and created a personal vision of wellness. Major themes associated with participation were supportive coaching relationship, increased self-accountability, increased goal-setting, and healthy behavior strategies. No significant barrier to participation was reported. Conclusion: Participants reported highly positive experience with the program; how to best integrate health and wellness coaching into the primary care setting needs to be explored

Impact of a 12-week wellness coaching on self-care behaviors among primary care adult patients with prediabetes

This single arm prospective study assessed the impact of individualized wellness coaching intervention for primary care patients with prediabetes on self-reported changes in physical activity level and food choices. Five hundred sixty adult patients 18 years and older with prediabetes, seen in primary care clinic, were invited to participate in 12 weeks wellness coaching sessions delivered by certified coaches. Responses from questionnaires at baseline, 6 and 12 weeks were analyzed. Of 168 consented patients, 99 completed at least one coaching session; majority was elderly, female, overweight or obese. At baseline, 50% had <60 min aerobic exercise/week. At 6 and 12 weeks, average aerobic exercise time significantly increased from 117 min to 166 and 199 min respectively. Effect was sustained at 24 weeks. Success in making healthy eating choices also statistically improved from baseline. Significant effects on both activity level and eating behavior persisted even after adjusting for age, sex and baseline glucose/A1c values. Secondary outcomes of self-efficacy and quality of life likewise showed significant improvement. Results suggest that integration of wellness coaching in primary care practice among individuals at high risk for diabetes is feasible and may be useful as part of diabetes prevention management strategies in target populations. Future randomized clinical trials are needed to further explore this issue. Keywords: Wellness coaching, Primary care, Prediabetes, Preventive health, Health behavio