Healthy Outcomes Through Patient Empowerment (HOPE), a telehealth intervention using collaborative goal setting and behavioral activation, can potentially improve depression symptoms in patients with diabetes and comorbid depression, according to study results published in JAMA Network Open.
Researchers conducted a randomized clinical trial in order to evaluate the effectiveness of proactive population screening and HOPE in high-risk patients with uncontrolled diabetes and depression. Of the 225 patients from a regional Veterans Healthcare System in Southeast Texas, 136 were enrolled in an intervention and 89 were in a control group. Data was gathered at baseline, 6, and 12 months after the intervention. All patients had been diagnosed with clinically significant depression and uncontrolled diabetes and lived more than 20 miles from a Veterans Affairs medical center. During the overall study, 59 patients were lost to follow-up or withdrew from the study.
HOPE included 9 telephone sessions with healthcare professionals focusing on behavioral activation and collaborative goal-setting. The control group received enhanced usual care and were notified of their high-risk status. Primary outcomes included change in depression symptoms (measured by the Patient Health Questionnaire–9 [PHQ-9]) and glycemic control using hemoglobin A1c (HbA1c). The secondary analyses evaluated any clinically significant responses for the above measures.
No significant improvement was found in PHQ-9 results or HbA1c through repeated-measures analysis. However, t-test analysis showed a change from baseline to 12 months for a PHQ-9 of 2.14 and an HbA1c of −0.06%. A secondary analysis of patients who experienced a clinical response found that 52.1% of HOPE patients had clinically significant responses as assessed by the PHQ-9 at 12 months vs 32.9% who received enhanced usual care (P =.01).
The study was limited by its male-dominant patient cohort, concentration on one geographical area, and focus on the Veterans Health Administration. These three factors may all influence the generalizability of the findings.
The researchers stated, “Although the intervention created some lasting effect for depression, additional strategies are needed to maintain engagement of this high-risk population within an interprofessional team approach to primary care.” They added that while these results support population-based screening of high-risk patients with diabetes and comorbid depressive symptoms for telephone delivery of care for chronic conditions, future studies are needed that focus on other settings and patient demographics.
Naik AD, Hundt NE, Vaughan EM, et al. Effect of telephone-delivered collaborative goal setting and behavioral activation vs enhanced usual care for depression among adults with uncontrolled diabetes: a randomized clinical trial. JAMA Netw Open. 2019;2(8):e198634.