Participatory design of patient-centered depression and diabetes care.

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DESCRIPTION (provided by applicant): There is a pressing need to improve outcomes for patients with diabetes, especially patients from underserved communities. Patients with diabetes have high levels of depressive symptoms that lead to poor engagement in care and worse overall health function. Integrated care for depression and diabetes has been shown to help improve clinical outcomes. However, many patients with depressive symptoms and diabetes, especially traditionally underserved groups, have other priorities such as financial, social and emotional concerns that affect their care. This K18 career enhancement award in Patient Centered Outcomes Research (PCOR) proposes, through a program of mentoring, formal coursework, and a linked research project, to build skills in PCOR methods and utilize a participatory approach to inspire a new services delivery model for diabetes care. The basis of this model would be to include patient's nonbiomedical needs as part of primary care treatment discussions and decisions. Partnering with patients, physicians, and licensed practical nurses (LPNs) as stakeholders, our first phase will use mixed-methods to determine the range of biomedical (physical symptoms, diet and exercise) and nonbiomedical (financial, social and emotional) needs patients with depressive symptoms and Type 2 DM may wish to address in the context of their health. These needs will be used to populate a prioritization card-sort task that will be used to create a personalized management plan that empowers patients to prioritize their own needs within an integrated care intervention. The second phase will prepare for a pragmatic comparative effectiveness trial by pilot testing an integrated depression and Type 2 diabetes mellitus (DM) intervention plus patient prioritized planning in primary care patients with depressive symptoms and Type 2 DM and a hemoglobin A1c (HbA1c) > 8% from urban clinics serving primarily older low income minority populations. Function will be our primary patient-centered outcome because of the importance patients place on being able to manage one's life circumstances. The intervention is carried out by health care staff already on site thus facilitatig its implementation in real world practices with limited resources and competing demands. Our goal is to close the health disparities gap in diabetes care among traditionally underserved groups including older adults, those in inner city areas, and members of minority groups.