Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial

被引:156
作者
Bogner, Hillary R. [1 ]
Morales, Knashawn H.
de Vries, Heather F.
Cappola, Anne R. [2 ]
机构
[1] Univ Penn, Perelman Sch Med, Dept Family Med & Community Hlth, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[2] Univ Penn, Dept Med, Div Endocrinol Diabet & Metab, Philadelphia, PA 19104 USA
关键词
Medication adherence; type 2 diabetes mellitus; depression; comorbidity; chronic disease; primary health care; randomized controlled trial; MINI-MENTAL-STATE; PRIMARY-CARE; RISK-FACTOR; COLLABORATIVE CARE; COST-EFFECTIVENESS; AFRICAN-AMERICAN; HEALTH; SYMPTOMS; INTERVENTIONS; ADULTS;
D O I
10.1370/afm.1344
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients. METHODS We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA(1c)) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA(1c) levels of less than 7% (intervention 60.9% vs usual care 35.7%; P < .001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs usual care 30.7%; P < .001) in comparison with patients in the usual care group at 12 weeks. CONCLUSIONS A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.
引用
收藏
页码:15 / 22
页数:8
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