A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic

• Published in: General hospital psychiatry 2017-01, Vol.44, p.10-15
• Main Authors: Chwastiak, Lydia A., MD MPH, Jackson, Sara L., MD MPH, Russo, Joan, PhD, DeKeyser, Pamela, MSN ARNP, Kiefer, Meghan, MD MPH, Belyeu, Brittany, MD, Mertens, Kathleen, MSN MPH RN, Chew, Lisa, MD MPH, Lin, Elizabeth, MD MPH
• Format: Article
• Language: English
• Subjects: Adult; Aged; Comorbidity; Delivery of Health Care, Integrated - organization & administration; Delivery of Health Care, Integrated - standards; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Feasibility Studies; Female; Hospitals, Urban; Humans; Male; Mental Disorders - epidemiology; Mental Disorders - therapy; Middle Aged; Outcome Assessment (Health Care); Patient Care Team - organization & administration; Patient Care Team - standards; Primary Health Care - organization & administration; Primary Health Care - standards; Program Evaluation; Psychiatry; Retrospective Studies; Safety-net Providers - organization & administration; Safety-net Providers - standards
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2016.10.005

Abstract Objective Demonstrate the feasibility of implementing a collaborative care program for poorly-controlled type 2 diabetes and complex behavioral health disorders in an urban academically-affiliated safety net primary care clinic. Methods This retrospective cohort study evaluates multidisciplinary team care approach to diabetes in a safety net clinic, and included 634 primary care clinic patients with hemoglobin A1c (HbA1c) > 9%. HbA1c, blood pressure, and depression severity were assessed at the initial visit and at the end of treatment, and compared to those of patients who were not referred to the team. Results The 151 patients referred to the program between March 2013 and November 2014 had a higher initial mean HbA1c: 10.6% vs. 9.4%, and were more likely to have depression (p = 0.006), anxiety (p = 0.04), and bipolar disorder (p = 0.03), compared to the 483 patients who were not referred. During the 18-month study period, there was a mean decrease in HbA1c of 0.9 (10.6 to 9.4) among those referred to the team, compared to a mean decrease of 0.2 (9.4 to 9.2) among those not referred. This was a significantly greater percent change in HbA1c (p = 0.008). Conclusion The integration of behavioral healthcare into chronic care management of patients with diabetes is a promising strategy to improve outcomes among the high risk population in safety net settings.