Celia Gote, DNP
Impact of Integrated Healthcare Delivery Service for Individuals with Type 2
Diabetes in the Behavioral Health Setting
Improved healthcare delivery with screening and early identification is important for prevention and treatment of patients with depression at risk for diabetes. The aim was to compare patients with depression in an integrated to a standard healthcare setting for the screening and identification of Type 2 Diabetes. Eight behavioral health providers (BHP) at five behavioral health clinics in a Community Health Center were randomized to standard or integrated care groups with convenience sampling to generate a list of patient appointments (152 subjects), Pre- and post-intervention data (BMI results, Type 2 Diabetes risk factors, and Al C test results) were used to examine the impact of an educational reminder prompt on rate of screening and early identification of Type 2 Diabetes Mellitus with patients who have depression.
It was hypothesized that BHPs in the integrated care group would screen andidentify a greater proportion of patients with Type 2 DM than provided in the standard care group. Additional analysis compared screening and identification of Type 2 Diabetes Mellitus by psychiatrists versus nurse practitioners. Compared to standard healthcare, integrated healthcare resulted in increased post-intervention BMI and diabetes risk factor identification (X2 = 16,29,p = .000), and lifestyle education (X2 =17.96,p ., ~ ,>; =.000). Patients in integrated healthcare were more likely to receive the post-intervention BMI screening and diabetes risk identification(r = -.327, P = .000), and lifestyle change education (r = -.344,p = .000). Odds ratio of having an AIC test ordered was six times greater for patients in the integrated arm than standard arm (95% Cl [2.57, 15.64],p = .0001). Additional analysis of psychiatrists compared to nurse practitioners demonstrated increase in post-intervention BMI and diabetes risk identification (X2 = 6.14,p =.013) and lifestyle education (X2 = 7.07, P = .008). Psychiatrists were more likely to perform diabetes risk identification (r = .201,p = .013) and lifestyle education (r= .216,p = .008). This main effect was not qualified by a significant interaction effect. Recommendations include continuing education with evidence-based guidelines and organizational leadership support for resources, such as care managers and electronic health record (clinical decision support).