The researchers randomized 214 patients enrolled in the Group Health Cooperative, a health care system in Washington state, to receive "usual care" in a primary-care setting or to get the collaborative care approach, called TEAMcare.
Those in the TEAMcare group were assigned to a nurse trained in all three conditions who worked with a primary care physician to monitor medication and lifestyle changes.
At the end of 12 months, patients in the team group saw improved blood sugar control, better LDL ("bad") cholesterol levels, lower systolic blood pressure and improvement with their depression.
Although the trial didn't last long enough to track actual health outcomes, the authors pointed out that improving these four measures has been associated in the past with fewer complications and death.
The TEAMcare approach cost $1,224 per patient for the year and the authors are now in the process of analyzing whether this actually saved the system money. These patients, on average, cost health-care systems $10,000 per year.
As always, though, the devil is in the details. "Implementation is the catch here," said Simon A. Rego, director of psychology training at Montefiore Medical Center in New York City. "This requires a lot of steps that, at the moment, don't happen together: coordination of resources, an excellently trained nurse practitioner, a nephrologist [and other specialists], and it's in the context of an HMO [health management organization]."
"This is a difficult model to implement outside of a large group practice," added Conwell. "A lot of the care delivered in the United States is in small practitioners so this would be difficult in some respects."
All rights reserved