Team care to help multiple chronic conditions

By Dr. Ananya Mandal, MDJan 2 2011

According to a new study patients with multiple chronic diseases like diabetes mellitus and heart disease are at higher risk of depression that can render medication ineffective. Lead researcher Dr. Wayne J. Katon and colleagues at University of Washington in the study found that patients who received care from nurses who worked with patients and physicians to manage the care for depression and diabetes and heart disease had better outcomes. The study was published in the Dec 30, 2010 issue of New England Journal of Medicine.

For the study the team compared two groups of patients, one received the standard care without any so called Teamcare, while the other received a Teamcare intervention. For teamcare intervention, a nurse helped monitor disease control like cholesterol, blood pressure, blood sugar and depression and worked closely with each patient’s primary physicians to help patients use medications effectively. End of year one, those receiving the Teamcare were found less depressed and had their blood sugar, cholesterol and blood pressure better controlled, compared with other patients with depression, diabetes mellitus and heart disease. These patients on Teamcare also reported that they were better satisfied and had a better quality of life. They had timely adjustments for blood sugar levels, high blood pressure, cholesterol and medications.

Study co-author Dr. Elizabeth Lin, a primary-care physician and researcher with Group Health Cooperative, a nonprofit healthcare organization based in Seattle said, “Up to this point, most care management has been focused on one condition at a time.” This is the first study that looks into multiple chronic conditions she said. Dr. Andrew Leuchter, a professor of psychiatry at UCLA added, “The study really shows a significant impact… They really completely overhauled how healthcare was delivered in this system.” Patients with three or more chronic conditions form 43% of Medicare beneficiaries and account for more than 80% of Medicare healthcare costs, the study noted. Leuchter said, “The problem is, the whole push in healthcare is to do things faster and cheaper… There is no push to spend more time with patients.”