Coordinated Care of Depression and Chronic Physical Illness

Depression in patients with diabetes or coronary artery disease is associated with poor disease control, adverse outcomes, and higher costs. Disease-specific chronic care management is expensive and impractical when patients have multiple chronic diseases or risk factors. Seattle investigators enrolled 214 patients with poorly controlled diabetes, coronary artery disease, or both, plus concomitant depression, and randomized them to usual care or to a structured, collaborative program that provided nurse-administered, guideline-based chronic care. Intervention patients received physician-supervised nursing outreach every 2 to 3 weeks with behavioral and motivational support, medication changes, and monitoring. After randomization, usual-care…