Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial

BMC Health Services Research

Aanand D Naik¹  Radha Rao²  Nicholas Masozera¹  Nancy J Petersen¹  Mark E Kunik³  Natalie Hundt³  Anne E Utech²  Suzanne Robertson¹  Jessica Y Breland²  Jeffrey A Cully³ 

[1]Baylor College of Medicine, Houston, TX, USA

[2]Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA

[3]VA South Central Mental Illness, Education, Research and Clinical Center, Virginia, USA

关键词: Veterans’ health;    Depression;    Diabetes mellitus;    Behavioral medicine;   

Others  :  1132639
DOI  :  10.1186/1472-6963-14-191

 received in 2013-08-16, accepted in 2014-03-28,  发布年份 2014

【 摘 要 】

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.

Trial registration

Behavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389.

【 授权许可】

   
2014 Cully et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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