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Nurse Leadership Helps Treatment of Patients With Multiple Conditions

Thursday December 30, 2010
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Team care led by a nurse appears to improve patient outcomes in cases of multiple chronic conditions such as heart disease, diabetes and depression.

Middle-aged patients with multiple conditions who experienced a team treatment approach using evidence-based guidelines improved in blood sugar, blood pressure, cholesterol control and depression, according to a study in the Dec. 30 issue of The New England Journal of Medicine.

“Depressed patients with multiple uncontrolled chronic diseases are at high risk of heart attack, stroke and other complications,” said lead study author Wayne J. Katon, MD, vice chairman of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. “We are excited about finding a new way to help patients control these chronic diseases, including depression.”

Of 214 patients in the Group Health Cooperative, a healthcare system in Washington state, researchers assigned some to receive standard care in the primary-care setting and some to receive collaborative care.

In the collaborative care setting, nurses worked with patients to set step-by-step goals such as reducing depression, blood sugar, blood pressure and cholesterol. Nurses worked with primary-care physicians to modify patients’ medications and lifestyles when they were not reaching their goals. Patients in the standard-care setting did not receive coaching and monitoring from nurses.

After a year, patients in the collaborative care group had improved blood sugar control, better LDL levels, lower systolic blood pressure and improvement with depression. The study did not track health outcomes, but improving such measures has been associated with fewer complications and deaths.

The collaborative-care approach cost $1,224 per patient, while such patients on average cost healthcare systems about $10,000 per year. Patients reported enhanced quality of life and satisfaction with care for depression and either diabetes, heart disease or both. They were more likely to have timely adjustment of glucose levels, high blood pressure, cholesterol and antidepressant medications.

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