HOPE Pilot for Veterans With Complex Diabetes

• Change in PHQ-9 scores, and change in HbA1c levels [ Time Frame: 3-6 months ] [ Designated as safety issue: No ]
  The coaching sessions take place over approximately 3 months -- outcomes are measured at 3 months and again at 6 months.
  
  

Behavioral: behavioral health coaching
Behavioral health coaching consisting of goal-setting, action planning, behavioral activation, and cogntive therapy is delivered by telephone over approximately 3 months.

The co-occurence of diabetes and depression is highly prevalent and has dramatic consequences for quality of life and health. Due to the complex interrelation between diabetes and depression, patients often experience both psychological and physiological difficulties. These comorbid problems demand focused interventions that blend physical and emotional health treatments with self-management strategies.Rural-dwelling veterans with diabetes and depression are typically treated in community-based outpatient clinics (CBOCs). Patients with diabetes in rural areas tend to have more problems controlling their blood sugar, blood pressure and cholesterol compared to urban patients; thereby increasing their risk of diabetic complications. Similarly, rural patients with depression have similar barriers to care that increase their risk of poorer health outcomes as well. Using behavioral health coaches (BHCs)to deliver telephone-mediated therapies may enhance the reach of treatments for co-occurring diabetes and depression. The implementation of such treatments requires the development and testing of therapeutic manuals and BHC training protocols to ensure standardization and effictiveness. The BHC intervention has been labeled Health Outcomes through Patient Empowerment (HOPE) and will be offered to eligible patients receiving care through MEDVAMC and its CBOCs. Preliminary data obtained through this pilot grant is to support a larger VA grant.