medwireNews: A telephone-delivered, collaborative goal-setting intervention can significantly reduce depressive symptoms relative to usual care in people with uncontrolled diabetes and clinically significant depression, research shows.
However, similar to usual care, the 6-month Healthy Outcomes Through Patient Empowerment (HOPE) intervention resulted in just “modest improvements in glycemic control at 12 months,” report Aanand Naik (DeBakey VA Medical Center, Houston, Texas, USA) and co-investigators.
They add that although the intervention “created some lasting effect for depression, additional strategies are needed to maintain engagement of this high-risk population within an interprofessional team approach to primary care.”
The trial included 225 US veterans identified through a learning healthcare systems approach who had a glycated hemoglobin (HbA1c) level above 7.5% and clinically significant depressive symptoms, defined as a Patient Health Questionnaire (PHQ)-9 score of 10 or higher, who lived more than 20 miles from their Veterans Affairs medical center.
The participants were randomly assigned to receive the HOPE intervention (n=136) or to usual care enhanced by notification of their high-risk status and the receipt of educational material (n=89).
Writing in JAMA Network Open, Naik et al explain that the intervention involved nine telephone sessions over 6 months with healthcare professionals (psychologists, nurses, pharmacists, and social workers) who used collaborative goal-setting to enhance behavioral activation targeting depression symptoms and diabetes self-care.
In the HOPE group, PHQ-9 fell from a mean score of 15.8 points at baseline to 10.9 points at 6 months and 10.1 points at 12 months. In the control group, the corresponding mean scores were 16.2, 12.4, and 12.6 points, resulting in significant differences between the groups of 1.74 and 2.14 points in favor of the intervention at the 6- and 12-month follow-ups, respectively.
By contrast, there were no significant differences between the two groups in HbA1c at either 6 or 12 months. HOPE participants had a mean baseline HbA1c of 9.2%, which fell slightly to 9.1% at 6 months and then to 8.7% at 12 months, while those receiving usual care experienced a reduction from 9.3% to 8.7% at 6 months then an increase to 8.9% at 12 months.
Of note, when the team used repeated-measures analysis with multiple imputation for missing data to assess the interaction between treatment group and time they found no significant improvement in either PHQ-9 or HbA1c.
Naik and co-authors say that their findings “underscore the difficulties of reaching and delivering care to a population by telephone who live at some distance from specialty diabetes and mental health care services.”
And they conclude: “These results provide some support for population-based screening of high-risk patients with diabetes and comorbid depressive symptoms for telephone delivery of care for chronic conditions.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
JAMA Netw Open 2019; 2: e198634