Patients’ Assessment of Chronic Illness Care: Results from a Controlled Implementation Trial of a Collaborative Primary Care Team Model for Diabetes and Depression

Abstract

We recently completed a non-randomized controlled trial to examine the effectiveness of a collaborative team care model (n=93) compared to enhanced usual care (n=61) for patients with type 2 diabetes and comorbid depression in primary care networks (TeamCare-PCN). Depressive symptoms and cardio-metabolic (A1c, systolic BP, LDL) were the main outcomes. As a secondary analysis, our objective was to explore whether this collaborative care model would enhance patients’ perceptions of the quality of care received and its congruence with the Chronic Care Model (CCM), using the Patient Assessment of Chronic Illness Care—11 items (PACIC). At baseline, the mean PACIC total score in the overall sample was 34.7 (SD=27.1), and 57% rated the quality of chronic care as low, 29% as medium, and 14% as high. Overall, there was a 16.0 point improvement (SD=28.9) in the PACIC total score over 12 months; 18.2 points (SD=30.4) in the intervention group compared to 12.8 points (SD=26.4) in the enhanced usual care group; this difference was not statistically significant (p=0.3), even after adjusting for age, sex and study site. In conclusion, patients with diabetes and depression generally rated the quality of chronic illness care they receive as less than optimal and minimally congruent with the CCM framework. Enhancing the usual care for these patients through active screening for depression, alerting their family physician and repeated assessment every 6 months improved patient’s ratings of their chronic illness care, and did so to a similar degree as compared to a more complex team-based intervention.