Depression or depressive symptoms are common in people with diabetes and are present in approximately 15% of people with diabetes – rates that are about 30% higher compared to the general population. Depressive disorders in people with diabetes are associated with poorer self-care behaviors, poorer glycemic control, health complications, decreased quality of life and psychological well-being, increased family problems, and higher health care costs.
A systematic review completed by our research group in 2009 showed that a nurse case manager working in a collaborative team care model with a family physician and psychiatrist provides a significant improvement in depression in patients with diabetes. A group from the University of Washington and Group Health Cooperative developed and named this model TEAMcare. For more information about their research, please visit the TEAMcare website at: www.teamcarehealth.org.
The ABCD project has adapted this model and applied it in the local Alberta primary care context through the implementation of the TeamCare-PCN intervention, in four PCNs (St. Albert Sturgeon, Leduc Beaumont Devon, Camrose and Alberta Heartland). This intervention focused on the treatment of depression, and included other areas of diabetes management in order to address other measures of disease control. The intervention consisted of three phases of treatment: Phase 1: interventions to improve depression symptoms; Phase 2; focus on disease control of blood sugar, blood pressure or cholesterol; and Phase 3: emphasis on improving lifestyle behaviors such as healthy eating, physical activity or smoking cessation.
The primary outcome is depression remission measured by the Patient Health Questionnaire (PHQ-9) survey. Secondary outcomes are cardio-metabolic changes including blood pressure, lipids and A1c reduction. In addition to these outcome measures, the TeamCare-PCN intervention is part of the ABCD project’s comprehensive evaluation framework. This evaluation component is critical understanding the full impact of TeamCare-PCN.
For a detailed description of the TeamCare-PCN intervention design, please click here.
For more information about the ABCD project evaluation, please click here.