Planned collaboration may seem like a no-brainer, but its use is far from typical in current health care systems. Two recent studies show that careful planning can improve patient out-comes and may serve as models that deserve wider consideration.

Figure. At Myrtue Medical Center in Harlan, Iowa, primary care physician Don Klitgaard and his colleagues have reorganized their small-town clinic into what they call a "medical home," where nurses, physicians, and a diabetes nurse educator are all part of the health care team. Photo by Nati Harnik / AP Photo.

In the first study, by Walker and colleagues, certified diabetes nurse educators were teamed with nonclinical health educators to compare the effects of a telephone intervention with those of an active control (printed materials) on glycated hemoglobin (HbA_1c) levels in 444 low-income, insured, mostly minority patients (62% black, 23% Hispanic) with type 2 diabetes. The authors found a mean decrease of 0.23% in HbA_1c levels in the telephone group, compared with a mean increase of 0.13% in those without telephone follow-up. Although these results were modest, the authors found that a greater number of calls (six or more) over the one-year study period was associated with even greater improvements in HbA_1c levels.

In the second study, also conducted over one year, Katon and colleagues used an integrated treat-to-target approach to managing care. Nurses, primary care physicians, psychiatrists, and psychologists collaborated to measure disease control in patients with poorly controlled diabetes, heart disease, or both; all patients also had symptoms of depression. Subjects were recruited from 14 primary care clinics in Washington State (roughly a quarter were of minority race or ethnicity). Three part-time RNs experienced in diabetes education served as communicators between the specialists and developed a maintenance plan with each patient; the nurses followed up with the patients by telephone every four weeks. Patients in the intervention group (n = 106) had better overall improvements in HbA_1c levels, cholesterol levels, systolic blood pressure, and depression scores than patients in the control group receiving usual care (n = 108). Patients in the intervention group had an average of 10 in-person and 10.8 telephone visits over the study period. The mean cost per patient was $1,224.

Both studies suggest that a well-planned interdisciplinary approach to improving disease self-management can result in better patient outcomes.-Gail M. Pfeifer, MA, RN