Integrating Behavioral Health Services for Individuals With Rheumatic Diseases: A Quantitative Analysis of a Pilot Study.

Abstract

Objective: Chronic pain, depressive and anxiety symptoms are common comorbidities among persons with rheumatic disease (RD) and contribute to increased symptom burden and reduced quality of life (QoL). Behavioral health (BH) interventions to motivate behavior change and promote self-management can effectively address these conditions. Despite potential benefits, efforts to integrate BH services into rheumatology clinics have been limited. We developed and piloted a BH program integrated within an academic rheumatology clinic to evaluate feasibility and impact on patient-reported outcomes (PROs).

Methods: Participants were adults with RD who chose one of three primary BH goals: increase physical activity, improve mood and/or anxiety, or manage pain. The BH specialist met via telephone with participants for up to eight sessions, which included psychoeducation, motivational interviewing, and mindfulness meditation, combined with supplemental apps and videos. Feasibility data included recruitment, retention, and intervention process data. PROs evaluated change from baseline to end assessment for pain interference, depression and anxiety, pain catastrophizing, QoL, and PRO Measurement Information System measures of fatigue, sleep disturbance, social satisfaction, and physical function. Sign-rank tests or paired Student's t-test were used to compare baseline and postintervention scores.

Results: Twenty-eight participants completed the program. Most (n = 15, 54%) chose the goal of improving mood and anxiety. Participants completed a mean of 6.86 (SD 1.56) sessions. Mean change scores demonstrated statistically significant improvements from baseline to end assessment across all PROs (P < 0.05), except social satisfaction and physical function (P > 0.05).

Conclusion: Integrating BH services within a rheumatology clinic was feasible and demonstrated promising trends in improvement of PROs, warranting future research to evaluate effectiveness and sustainability.