Medical and Mental Health Integration; Diabetes and Depression Care. Mercy Moto MSN, DNP-c DNP Project April, 2018 Chair: Dr.

Transcription

1 Medical and Mental Health Integration; Diabetes and Depression Care Mercy Moto MSN, DNP-c DNP Project April, 2018 Chair: Dr. Moore

2 PICO Question What is the impact of BHT on Type 2 diabetic mellitus (T2DM) patients who are screened and subsequently diagnosed with depression, as evidenced by repeated outcome measures, utilizing the Patient Health Questionnaire-9 depression scale (Phq-9) and Hemoglobin A1c results?

3 Background No Health without Mental Health (Chisholm, 1954) Over 25% living with mental illness (CDC, 2011) Nearly half develop a mental illness in their lifetime (CDC, 2011) A diagnosis of diabetes Increases your risk for developing depression (ADA, 2013) Bidirectional relationship of diabetes and depression? Stress of managing diabetes leads to depression Depression can also lead to poor lifestyle decisions (Mayoclinic, 2017)

4 Background Integrating BH services into primary care: 1) Decreases stigma toward people with mental illness (WHO, 2011) 2) Improves access to mental health services Integrated care of patients with comorbid T2DM and depression improves rates of adherence to oral hypoglycemic agents and antidepressants, and improves glucose control and decreases Depressive symptoms (Bogner, Morales, Vries, & Cappola, 2012)

5 Significance Mental Illness life expectancy: 10 to 25 years less than others (WHO, n.d) The concept of integrating physical health with mental health has been supported at local, state, national, and global levels. It makes sense to adapt this process not only from an economic standpoint, but more importantly, from an ethical standpoint. It is significant that providers screen diabetic patients for signs of depression and take appropriate steps to address these needs or hand over their care to a psychiatrist who can co-manage the patient s health with the primary care provider (Gregory et. al, 2016)

6 Nola Pender s HPM Theory Major concepts of the HPM in managing diabetes and depression (Pender, 2011) Individual characteristics and experiences Prior behavior-specific knowledge Prior behavior outcome

7 Objectives To identify: 1) the correlation between BHT and Phq-9 scores and HbA1c results. 2) the need for an evidence-based depression screening algorithm tool for provider use

8 Method IRB approval Retrospective chart review of 2 EMRs in integrated outpatient clinic- 24 charts Variables- Phq-9, HbA1c, BHT, and BMI The Phq-2 has a 97% sensitivity and 67% specificity in adults Phq-9 has a 61% sensitivity and 94% specificity in adults (Maurer & Darnel, 2012)

9 Demographics Engagement in BHT- 10, None Therapy-13 Almost 61% of the patients had Medicaid insurance 30% had Medicare insurance 33% were found to be homeless Caucasion 16 AA 5 Hispanic 1 Asian 1 Other 1 Age- Ranged 25-65

10 Data Analysis SPSS data Analysis -α set at 5% SPSS Independent samples t tests for initial Phq-9, subsequent Phq-9 and BHT Initial Phq-9: significance p =.011 Subsequent Phq-9 no statistical significance Initial and subsequent HbA1c no statistical significance Pearson Correlation- Moderate positive correlations between HbA1c and Phq-9 scores r=.36, n=19, p=.129

11 Study Limitations Lack of standard documentation between BH and medical providers Small sample size Missing data Multiple EMR systems Inconsistent data entry and depression screening

12 Implications for Practice Primary care providers working in integrated health settings are in a unique position to identify and address depression and diabetes comorbidities. Additional study is needed to determine the impact of a consistent behavioral health intervention on patients with T2DM and depression. Screening for depression in patients with diabetes is an important aspect of providing holistic care to this population (USPSTF, 2018)

13 No Health Without Mental Health Thank You Mercy Moto APN, FNP-BC, DNPc Any Questions?