Association of collaborative care intervention features with depression and metabolic outcomes in the INDEPENDENT study: A mixed methods study.
Prim Care Diabetes
; 18(3): 319-326, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38360505
ABSTRACT
AIMS:
The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) trial tested a collaborative care model including electronic clinical decision support (CDS) for treating diabetes and depression in India. We aimed to assess which features of this clinically and cost-effective intervention were associated with improvements in diabetes and depression measures.METHODS:
Post-hoc analysis of the INDEPENDENT trial data (189 intervention participants) was conducted to determine each intervention feature's effect 1. Collaborative case reviews between expert psychiatrists and the care team; 2. Patient care-coordinator contacts; and 3. Clinicians' CDS prompt modifications. Primary outcome was baseline-to-12-months improvements in diabetes control, blood pressure, cholesterol, and depression. Implementer interviews revealed barriers and facilitators of intervention success. Joint displays integrated mixed methods' results.RESULTS:
High baseline HbA1c≥ 74.9 mmol/mol (9%) was associated with 5.72 fewer care-coordinator contacts than those with better baseline HbA1c (76.8 mmol/mol, 9.18%, p < 0.001). Prompt modification proportions varied from 38.3% (diabetes) to 1.3% (LDL). Interviews found that providers' and participants' visit frequencies were preference dependent. Qualitative data elucidated patient-level factors that influenced number of clinical contacts and prompt modifications explaining their lack of association with clinical outcomes.CONCLUSION:
Our mixed methods approach underlines the importance of the complementarity of different intervention features. Qualitative findings further illuminate reasons for variations in fidelity from the core model.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Equipe de Assistência ao Paciente
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Hemoglobinas Glicadas
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Biomarcadores
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Prestação Integrada de Cuidados de Saúde
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Comportamento Cooperativo
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Sistemas de Apoio a Decisões Clínicas
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Depressão
Tipo de estudo:
Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article