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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3001 — Results of a Randomized Trial of Telephone Counseling Plus Walking for Depressed Diabetes Patients Treated in VA and Non-VA Settings

Beard AJ (Ann Arbor VA Healthcare System and University of Michigan, Ann Arbor), Richardson C (Ann Arbor VA Healthcare System and University of Michigan, Ann Arbor), Valenstein M (Ann Arbor VA Healthcare System and University of Michigan, Ann Arbor), Duffy S (Ann Arbor VA Healthcare System and University of Michigan, Ann Arbor), Striplin D (Ann Arbor VA Healthcare System), Piette JD (Ann Arbor VA Healthcare System and University of Michigan, Ann Arbor)

Objectives:
A recent trial of telephone nurse management for patients with comorbid diabetes and depression showed intervention impacts on several outcomes. We examined whether intervention effects on physiologic control, depressive symptoms, and self-care behaviors differed between VA and non-VA patient participants.

Methods:
291 patients with diabetes and depressive symptoms were recruited from VA (n = 98), community (n = 88), and university (n = 105) healthcare systems. Patients were randomized by site to usual care or the intervention. A telephone CBT program was delivered by nurses weekly for 12 weeks, followed by nine monthly booster sessions. Sessions initially focused on patients’ depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c measured at 12 months. Physical activity was determined by pedometer readings, and patient interviews contained standard scales. Differences in the impact of the intervention by site were analyzed using regression models with site by treatment interactions.

Results:
There was no impact on A1c in the overall sample or in site-specific subgroups. Intervention patients had greater increases than usual care in step-counts (mean difference 1,131 steps/day; p = 0.0002) and greater reductions in depressive symptoms (58% remitted at 12 months versus 39%; p = 0.002). At 12 months, VA patients in the intervention group had 903 more steps/day, on average, than Veterans receiving usual care. VA intervention patients experienced a nearly 4-point reduction in BDI scores compared to usual care – equivalent to the overall sample. VA intervention-group patients, compared to usual care, experienced improvements at follow-up in their physical activity-specific self-efficacy (p = 0.003), satisfaction with services (p < 0.0001), social functioning (p = 0.05), and role limitations due to physical health (p = 0.02). VA intervention participants were significantly more satisfied with their care than university intervention participants at 12 months (p = 0.03).

Implications:
This program of telephone-delivered CBT combined with a pedometer-based walking program increased patients’ physical activity and decreased depressive symptoms both overall and within the VA subgroup. VA intervention participants reported more program satisfaction than VA usual care participants or intervention participants at other sites.

Impacts:
This telephone-delivered program for Veterans with comorbid diabetes and depression could enhance patient-centered care as part of the PACT initiative.


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