Impact of collaborative care model treatment for depression and anxiety on cardiovascular risk factors using electronic health record data

IF 4.9 2区 医学 Q1 CLINICAL NEUROLOGY
Allison J. Carroll , Sarah E. Philbin , Olutobi A. Sanuade , Emily S. Fu , Andrew D. Carlo , Havisha Pedamallu , Saneha Borisuth , Lisa J. Rosenthal , Jeffrey T. Rado , Neil Jordan , Inger E. Burnett-Zeigler , C. Hendricks Brown , Justin D. Smith
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Abstract

Background

Primary care patients with depression or anxiety are at higher risk for cardiovascular disease. Those who engage in integrated mental health treatment may also improve their cardiovascular health.

Methods

We conducted secondary analysis of electronic health record-extracted data related to a pragmatic, implementation trial of the collaborative care model for depression and anxiety (CoCM; NCT04321876). Primary care patients with elevated depressive/anxiety symptoms (N = 3252) in 11 primary care clinics were classified as CoCM Patients (n = 718), Not Referred to CoCM (n = 1348), or Not Engaged in CoCM (n = 1459). Cardiovascular health measures included blood pressure (BP; mmHg), total cholesterol (mg/dL), HbA1c (%), and body mass index (BMI; kg/m2). Primary analyses were linear regressions evaluating associations of CoCM treatment (vs. Not Referred, vs. Not Engaged) with changes in cardiovascular health, adjusted for demographics, cardiovascular diagnoses, and medications.

Results

At baseline, CoCM Patients had poorer cardiovascular health than Not Referred (higher systolic BP, total cholesterol, BMI) and better cardiovascular health than Not Engaged (lower total cholesterol, HbA1c). CoCM Patients, vs. Not Referred, had small decreases in total cholesterol (B = −0.44, 95 % CI: −0.72, −0.17) and increases in BMI (B = 0.18, 95 % CI: 0.03, 0.34). CoCM Patients did not differ from Not Engaged patients on cardiovascular health outcomes (all ps > 0.05).

Discussion

Differences in cardiovascular health profiles were evident prior to treatment. Patients who bengaged in CoCM treatment, compared to patients not referred to CoCM, evidenced small improvements in total cholesterol and increases in BMI. Widespread implementation of integrated mental health treatment may have implications for population cardiovascular health.
基于电子健康记录数据的协同护理模式治疗抑郁和焦虑对心血管危险因素的影响
背景:患有抑郁或焦虑的初级保健患者发生心血管疾病的风险较高。那些从事综合心理健康治疗的人也可能改善他们的心血管健康。方法:我们对电子健康记录提取的数据进行了二次分析,这些数据与抑郁症协作护理模式(CoCM;NCT04321876)。11家初级保健诊所出现抑郁/焦虑症状升高的初级保健患者(N = 3252)分为CoCM患者(N = 718)、未提及CoCM (N = 1348)和未参与CoCM (N = 1459)。心血管健康指标包括血压(BP;mmHg)、总胆固醇(mg/dL)、HbA1c(%)和体重指数(BMI;kg / m2)。初步分析采用线性回归评估CoCM治疗(vs.未转诊、vs.未转诊)与心血管健康变化的关系,并根据人口统计学、心血管诊断和药物进行调整。结果:在基线时,CoCM患者的心血管健康状况比未就诊患者差(收缩压、总胆固醇、BMI较高),比未就诊患者的心血管健康状况好(总胆固醇、HbA1c)。CoCM患者与未提及的患者相比,总胆固醇有小幅下降(B = -0.44,95 % CI: -0.72, -0.17), BMI增加(B = 0.18,95 % CI: 0.03, 0.34)。CoCM患者与未参与的患者在心血管健康结局方面没有差异(所有ps > 0.05)。讨论:治疗前心血管健康状况的差异是明显的。与未接受CoCM治疗的患者相比,接受CoCM治疗的患者总胆固醇略有改善,BMI有所增加。综合心理健康治疗的广泛实施可能对人群心血管健康产生影响。
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来源期刊
Journal of affective disorders
Journal of affective disorders 医学-精神病学
CiteScore
10.90
自引率
6.10%
发文量
1319
审稿时长
9.3 weeks
期刊介绍: The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.
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