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 In a survey of 37 top institutions, most of them treating thousands
of diabetes patients per year, barely 4 in 10 said they had a
behavioral health professional integrated into the practice, and
even these were typically just part-time.
In contrast, 100 percent had full-time hormone specialists known as
endocrinologists, 98 percent had diabetes educators and 92 percent
had registered dieticians and nurse practitioners, the study team
reports in a research letter to the journal Diabetes Care.
Past research "suggests that psychosocial interventions . . .
improve diabetes outcomes and that behavioral interventions aimed at
changing self-management behaviors have been associated with
improvements in quality of life," lead author Samantha Barry,
Diabetes Center of Excellence at the University of Massachusetts
Medical Center in Worcester said in an email.
In late 2016, the American Diabetes Association (ADA) put out
guidelines urging that psychosocial care should be a standard part
of diabetes care, and encouraging medical providers to identify and
coordinate with qualified behavioral and mental health care
professionals, Barry and her colleagues note. The recommendation was
reiterated in the latest ADA standard of care guidelines.
To see whether mental health support is becoming more common,
Barry's team identified diabetes practices that were members of the
ADA or American Diabetes Educators Association and sent a survey to
each clinic's leadership. Seventy percent of the centers attended to
more than 2,000 patients annually and 87 percent were located in
teaching hospitals.
Of the 15 clinics that reported having a behavioral health
professional integrated into the practice, about one third had a
psychologist and the rest had a social worker. Of the 22 practices
with no behavioral health professional, five said they had
identified an outside practitioner with diabetes expertise to whom
they could refer patients.
On average, practices employed the equivalent of nearly six
full-time endocrinologists and nearly three each of full-time
certified diabetes educators and full-time nurse practitioners, with
about two full-time registered dietitians. Among the practices with
an in-house behavioral health presence, the average was 0.6
full-time-equivalents, researchers found.
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One reason for the lack of progress on this front may be that there
has been minimal investment in developing this aspect of diabetes
care, and the reimbursement rates for mental health providers often
make it so that institutions will lose money when providing these
services, said Jeffrey Gonzalez of the Albert Einstein College of
Medicine in New York City, who wasn't involved in the study.
"It's also true that few mental health providers have a full
understanding of diabetes and its treatment," Gonzalez said in an
email.
The ADA and American Psychological Association recently launched a
directory of mental health professionals with training or experience
in diabetes care (bit.ly/2qwpecx).
While certified diabetes educators play an integral role in
providing information to diabetes patients, "they do not delve into
how to apply this overwhelming material into a person's new life as
a diabetic," said study co-author Dr. David Harlan, also with the
U.Mass Medical Center Diabetes Center of Excellence, in a telephone
interview.
"Several mental health problems, such as depression and anxiety, are
common among those living with diabetes," Gonzalez said. "Care team
members with specialized mental health expertise are more likely to
play a significant role in addressing these issues in ways that
maximize the effectiveness of diabetes treatments."
"Behavioral health integration is crucial," Barry said. "As a
country, we need to move towards behavioral health integration in
line with recommendations supported by the literature. We're not
there yet."
SOURCE: https://bit.ly/2Ils93E Diabetes Care, online April 30, 2018.
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