A clinical trial has proven the efficacy of nurse-dispensed, primary care physician-supervised health education in the reduction of depression symptoms of patients with poorly controlled diabetes or coronary heart disease.
An American randomized controlled trial of Katon and his colleagues published in the New England Journal Medicine in 2010 assessed the benefits of a health education program on the health and depression symptoms of poorly controlled diabetes or coronary heart disease patients. The program was implemented by nurses and primary care physicians. The results of the study showed increased medication adherence, improved control of the organic disease and a reduction of depressive symptoms in the health education group, compared to the control group, who only received standard medical advice.
The Study Rationale
Treating patients with multiple comorbidities is challenging. These patients are more vulnerable to pathogens and more likely to be hospitalized. The cost of their care is multiplied by 4. One of the ways in which we can improve their condition is health education.
Patient education could be a very beneficial solution for patients with multiple chronic diseases.
Can a health education program implemented by nurses under primary care physician supervision positively impact the condition of depressed people with poorly controlled diabetes or coronary heart disease?
This randomized controlled trial assessed the efficacy of a health education program implemented by nurses and primary care physicians. The study included 214 patients aged 56 years on average. Participants in the non-pharmacological intervention group were offered a 1-year health education program. The healthcare professionals involved were qualified nurses. They were experienced in diabetes control, coronary heart disease and depression management. They collaborated with primary care physicians. Together they provided a complete guide to medicated disease control, depression management, and overall health optimization. They met with patients every 2-3 weeks, to monitor medication adherence (for hypertension, hyperlipidemia, hyperglycemia and depression) and review proper medication intake techniques according to medical prescriptions. The nurses were trained in motivational strategy (planning, problem-solving, behavior activation). They encouraged patients to follow the prescribed treatments, to monitor disease evolution (e.g., self-monitoring of glycemia levels) and to better manage their health. A video and a booklet on how to cope with organic disease-induced depression were issued to patients. The nurses received weekly supervision with a psychiatrist, a primary care physician and a psychologist to review new cases. Once patients were able to manage their disease autonomously, a self-management maintenance plan was proposed to them. Every month, the nurses called patients on the phone to verify that they effectively and correctly implemented all self-treating procedures. The control group patients received standard care. They were advised to consult their primary care physician for any depressive symptoms.
The results evidenced an improvement in all pathological disease biomarkers (glycated hemoglobin, LDL, cholesterol and blood pressure levels) for the health education group, compared to those of the control group. Patients also saw a reduction of their depressive symptoms, and expressed heightened satisfaction about their treatment and quality of life.
Patient education improves patient compliance of patients with multiple chronic diseases.
What it means for Patients
Health education improved the health of patients with chronic diseases, particularly by reducing their level of depression.
What it means for Healthcare Professionals
When provided by nurses and primary care physicians, health education improves medication adherence. However, it has not effect upon diet habits or weekly physical activity.
What it means for Researchers
The results of a randomized control trial assessing the efficacy of a non-pharmcological intervention such as a health education program can be published in one of the most prestigious medical journals in the world, the New England Journal Medicine.
What it means for Policymakers
Patients suffering from multiple chronic diseases present complex treatment challenges. They should systematically be offered health education programs. This was brilliantly illustrated in this study by the collaborative work of nurses and primary care physicians in a medical center.
Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, Mc Gregor M, McCulloch D (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal Medicine, 363, 2611-2620.
To reference this Blog en Sante © article.
Ninot G (2014). Disease management program mitigates the depression in patients with chronic disease. Blog en Sante, A31.
© Copyright 2014 Grégory Ninot. All rights reserved.
Thanks to Syl Billere for the English Revision