Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
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DOI：
10.1186/1472-6963-14-191
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发表时间：
2014-04-28
影响因子：
2.8
通讯作者：
Naik, Aanand D.
中科院分区：
文献类型：
--
作者：
Cully, Jeffrey A.;Breland, Jessica Y.;Naik, Aanand D.
背景资料：抑郁症和糖尿病对患者和医疗保健系统造成重大负担，并且当同时发生时，与单独的任何一种疾病相比，会导致更差的自我护理行为和更差的血糖控制。然而，这些合并症的临床管理是复杂的患者，供应商和系统级的障碍，尤其是在农村地区的患者的主机。以病人为中心的医疗之家提供了一个机会，整合精神和身体健康护理，以解决复杂的共病条件的多方面需求。目前，不仅需要为复杂的医学疾病患者制定强有力的临床干预措施，而且需要找到可行的方法将这些干预措施嵌入现有初级保健实践的第一线。方法/设计：这项随机对照试验使用混合有效性-实施设计来评估通过患者赋权（HOPE）干预的健康结局，旨在同时解决德克萨斯州东南部农村退伍军人的糖尿病和抑郁症问题。总共招募了242名糖尿病未得到控制并伴有抑郁症症状的退伍军人，随机分配到HOPE干预组或常规护理组。参与者将在基线和6个月及12个月随访时接受一系列糖尿病和抑郁症相关指标的评估。该试验有两个主要目标：1）检查干预对身体和精神的有效性。（糖尿病）和情绪健康（抑郁症）的结果和2）同时试点测试多方面的实施策略，旨在提高忠诚度和利用的干预教练在初级保健设置接口。这种正在进行的混合有效性实施设计有可能在忙碌的以患者为中心的医疗之家的限制内推进护理复杂医学疾病患者的科学和实践。
Background: Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices.Methods/design: This randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting.Discussion: This ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home.