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Team-Based Treatment Helps Those With Cluster of Chronic Illnesses
Date:12/30/2010

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Dec. 29 (HealthDay News) -- A treatment team headed by an experienced nurse improved the health of patients suffering from multiple chronic illnesses such as heart disease, diabetes and depression.

A study appearing in the Dec. 30 issue of the New England Journal of Medicine reports improvements in the four areas of blood sugar, blood pressure, cholesterol control and depression in middle-aged patients offered this treatment strategy.

"The results were great. All of the key parameters improved in the intervention group compared with the controls," said study author Dr. Wayne J. Katon. "And the intervention patients were less disabled at the end of one year, rated their quality of life as higher and were more satisfied with medical care."

People with chronic illnesses often don't get optimal care in primary-care settings, noted Katon, who is vice chairman of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle.

"[In primary-care clinics], at least 50 percent of people with diabetes have blood sugars above guidelines and many people with high blood pressure don't get enough pills or aren't taking them," he said. "Similarly with depression, only about one-quarter of people get guideline-level care in primary care."

And people with three or more illnesses are expensive, accounting for 60 percent to 80 percent of Medicare costs, he added.

A team-based, "collaborative care" strategy has been shown to work in control of heart disease, of diabetes or with depression, but no one has yet looked at all three in tandem.

Depression, said Dr. Yeates Conwell, co-director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, "typically goes along with a lot of other medical conditions, tends to interact with those conditions, complicate treatment and worsen o
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