Disease Management Update
Volume V, No. 48
April 16, 2009
Dear Healthcare Intelligence Network Client,
In disease management, it is equally important to pay attention to both conditions patients have, as well as what their current conditions can cause. This week's DM Update highlights two studies that showcase links between depression and some otherwise non-related conditions — what depression can cause as well as what it can result from.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
1. Depression After Heart Disease Ups Risk of Heart Failure
Heart disease patients who are subsequently diagnosed with depression are at greater risk for heart failure, according to a new study by cardiac researchers at Intermountain Medical Center. The study is the first of its kind to investigate the influence of depression after heart disease on the likelihood of developing heart failure. Researchers also found that taking antidepressant medications to ease depressive symptoms did not appear to mitigate this risk.
Researchers found that a depression diagnosis following coronary heart disease was associated with a two-fold increased risk for the incidence of heart failure. This risk remained, but was slightly lower after adjusting for other cardiovascular risk factors like diabetes, hypertension and age. The incidence of heart failure among patients who were not depressed after being diagnosed with coronary artery disease was 3.6 per 100 compared with 16.4 per 100 for those with a post-heart disease depression diagnosis.
“Our findings indicate that it may be important for clinicians to keep in mind that although a patient’s depressive symptoms may improve, the risk for harmful cardiovascular outcomes related to depression might not,” said Heidi May, Ph.D., M.S.P.H., an epidemiologist at Intermountain Medical Center and lead author of the study. “Patients need to be carefully screened for depression so that interventions that alter some of the risk associated with depression can be used and the related risk of heart failure and other cardiovascular events can be diminished.”
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2. Disease Management Q&A: Overcoming Resistance in Depression Management
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Sam Toney, president and chief medical officer of Health Integrated, Inc.
Question: How can we get resistant members to comply with psychotherapy for depression?
Response: (Dr. Sam Toney) Not all individuals with depressive disorder meet criteria for psychotherapy. It’s a very important treatment intervention. Literature tells us that the most successful treatment interventions are dual modality interventions. Typical anti-depressant therapies, medication management and psychotherapy tend to produce the best results in combination. You must assess an individual’s readiness and willingness to change. The qualification or clarification of appropriateness for psychotherapy is the first part of that equation. Determining that this patient meets criteria for psychotherapeutic intervention involves looking at the patient’s readiness to accept that intervention. Then we work with the patient through motivational interviewing and behavior change techniques provided by our clinicians to move that patient toward acceptance of that treatment modality. It’s important to avoid employing psychotherapeutic interventions ourselves. This is sometimes a challenge for our clinicians, most of whom are psychotherapists, because there’s a temptation to enter into the therapeutic relationship. Thus, we have frequent in-house reminders that we render educational services to our care managers and that line cannot be crossed. We utilize certain techniques and interviewing skills to move our patients into acceptance of that modality.
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3. HealthSounds Podcast: Achieving the ROI in DM
Nightly data mining has helped Vanderbilt University and Medical Center identify and make contact with high-risk high-volume patients, explains Dr. Dexter Shurney, which has vastly improved patient outcomes and closed care gaps. But the medical director of Vanderbilt's Employee Health and Care Plan would like to see even more data put in front of physicians at the point of care — especially regarding certain patients with no claims history. Dr. Shurney describes these "bombs waiting to explode," as well as the impact of the PCMH model of care on DM and why wellness and prevention services may be the best responses to individuals with comorbidities.
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4. Diabetes a Risk Factor for Postpartum Depression
Harvard Medical School and the University of Minnesota School of Public Health report that low-income women with diabetes have a more than 50 percent increased risk of experiencing postpartum depression. To investigate the potential link between diabetes and postpartum depression, researchers examined medical claims data from the New Jersey Medicaid program, looking at information from 11,024 new mothers who had given birth between July 2004 and September 2006. All women in the study were eligible for Medicaid six months prior to and one year after delivery and had incomes less than 115 percent of the federal poverty line. Study data indicated that 9.6 percent of women with diabetes, who had no indication of depression during pregnancy, developed depression during the year following delivery, compared with 5.9 percent of women without diabetes. Pregnant women and new mothers with diabetes were approximately 55 to 60 percent more likely to experience postpartum depression. The increased risk of postpartam depression is similar for women who already had diabetes and those who developed it during pregnancy. “Healthcare facilities and clinicians that serve low-income and Medicaid populations may want to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period," said Katy Backes Kozhimanni, research fellow in the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care.
To learn more about this research, please visit:
5. Survey of the Month: Managing Care Transitions Across Sites
Planning a patient's care transitions and closing the gaps in care from one healthcare setting to another can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers, and the burden on caregivers and family members. Please share your organization's experiences with care transitions by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
To participate in this survey and receive its results, please visit:
6. Targeting Depression Through DM
Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an October 2008 e-survey from HIN, 250 healthcare professionals shared how their organizations are targeting depression as part of their disease management (DM) initiatives.
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