Pharmacist-led group medical appointments for the management of type 2 diabetes with comorbid depression in older adults.
BACKGROUND
Depression is associated with poor glycemic control, increased number of microvascular and macrovascular complications, functional impairment, mortality, and 4.5 times higher total health care costs in patients with diabetes. Shared medical appointments (SMAs) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support, counseling, problem solving, and improved access to care.


OBJECTIVE
To test the efficacy as assessed by attainment of a hemoglobin A(1c) (A1C) <7% of pharmacist-led group SMA visits, Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression (VA-MEDIC-D), in patients with type 2 diabetes mellitus.


METHODS
This was a randomized controlled trial of VA-MEDIC-D added to standard care versus standard care alone in depressed patients with diabetes with A1C >6.5%. VA-MEDIC-D consisted of 4 once-weekly, 2-hour sessions followed by 5 monthly 90-minute group sessions. Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes, lipids, smoking, and blood pressure. No pharmacologic interventions for depression were provided. The change in the proportion of participants who achieved an A1C <7% at 6 months was compared.


RESULTS
Compared to standard care (n = 44), a lower proportion of patients in VA-MEDIC-D (n = 44) had systolic blood pressure (SBP) <130 mm Hg at baseline, but were similar in other cardiovascular risk factors and psychiatric comorbidity. The change in the proportion of participants achieving an A1C <7% was greater in the VA-MEDIC-D arm than in the standard care arm (29.6% vs 11.9%), with odds ratio 3.6 (95% CI 1.1 to 12.3). VA-MEDIC-D participants also achieved significant reductions in SBP, low-density lipoprotein cholesterol, and non-high-density lipoprotein (HDL) cholesterol from baseline, whereas significant reductions were attained only in non-HDL cholesterol with standard care. There was no significant change in depressive symptoms for either arm.


CONCLUSIONS
Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms.
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence Veterans Administration (VA) Medical Center, Providence, RI, USA. TTaveira@uri.edu
Tracey H
TH
Taveira
Andrea G
AG
Dooley
Lisa B
LB
Cohen
Sameed Ahmed M
SA
Khatana
Wen-Chih
WC
Wu
D001071:Appointments and Schedules; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000009:adverse effects; D008078:Cholesterol, LDL / Q000009:adverse effects; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D004630:Emergencies; D005260:Female; D006755:Hospital Shared Services / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods; D010595:Pharmacists; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL