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

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...

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Autores principales: Cully, Jeffrey A, Breland, Jessica Y, Robertson, Suzanne, Utech, Anne E, Hundt, Natalie, Kunik, Mark E, Petersen, Nancy J, Masozera, Nicholas, Rao, Radha, Naik, Aanand D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045905/
https://www.ncbi.nlm.nih.gov/pubmed/24774351
http://dx.doi.org/10.1186/1472-6963-14-191
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author Cully, Jeffrey A
Breland, Jessica Y
Robertson, Suzanne
Utech, Anne E
Hundt, Natalie
Kunik, Mark E
Petersen, Nancy J
Masozera, Nicholas
Rao, Radha
Naik, Aanand D
author_facet Cully, Jeffrey A
Breland, Jessica Y
Robertson, Suzanne
Utech, Anne E
Hundt, Natalie
Kunik, Mark E
Petersen, Nancy J
Masozera, Nicholas
Rao, Radha
Naik, Aanand D
author_sort Cully, Jeffrey A
collection PubMed
description 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.
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spelling pubmed-40459052014-06-06 Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial Cully, Jeffrey A Breland, Jessica Y Robertson, Suzanne Utech, Anne E Hundt, Natalie Kunik, Mark E Petersen, Nancy J Masozera, Nicholas Rao, Radha Naik, Aanand D BMC Health Serv Res Study Protocol 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. BioMed Central 2014-04-28 /pmc/articles/PMC4045905/ /pubmed/24774351 http://dx.doi.org/10.1186/1472-6963-14-191 Text en Copyright © 2014 Cully et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Study Protocol
Cully, Jeffrey A
Breland, Jessica Y
Robertson, Suzanne
Utech, Anne E
Hundt, Natalie
Kunik, Mark E
Petersen, Nancy J
Masozera, Nicholas
Rao, Radha
Naik, Aanand D
Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title_full Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title_fullStr Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title_full_unstemmed Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title_short Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
title_sort behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045905/
https://www.ncbi.nlm.nih.gov/pubmed/24774351
http://dx.doi.org/10.1186/1472-6963-14-191
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