Study shows widespread benefits of collaborative care model

Offered treatment for depression, pain or inactivity, participants with spinal cord injuries saw improvement in all areas.

Spinal cord injuries are among the most complex cases healthcare professionals must manage. In addition to their life-altering injury, people with spinal cord injury face seven to eight additional chronic conditions that often work in concert to make life especially challenging for someone already undergoing a great deal of change. 

Now, psychologists and physicians at the University of Washington School of Medicine believe they’ve found a way to make that journey less difficult through collaborative care. This is a method involving a care coordinator who helps deliver proactive, integrated medical and psychological treatment for pain, depression and physical inactivity under the supervision of a multidisciplinary team of doctors. 

“Clinicians are treating these chronic conditions as best they can within the traditional outpatient care model,“ said Chuck Bombardier, a psychologist and professor of rehabilitation medicine. “And this should just point out that we really aren't helping these patients as much as we could if we had more integrated medical and psychological care. And for not that much more time and money, you can get quite a bit of bang for the buck. It shows that if we took a proactive, collaborative approach to these problems our patients would be better off and satisfaction with care would increase. But the U.S. health care system just does not support this sort of value-based care.” 

The study is scheduled to appear in the Journal of Neurotrauma and is now available in a prepress edition. The seven researchers involved come from the UW Medicine departments of rehabilitation medicine, psychiatry and behavioral sciences, neurological surgery, and biostatistics, and the Spinal Cord Injury Service of the VA Puget Sound Health Care System, Seattle Division.

When a patient with a spinal cord injury moves beyond acute rehabilitation and into the chronic phase of coping with their condition, there isn’t usually a guide to help that person learn to manage all their various issues. Primary care physicians may not be that knowledgeable about spinal cord injury. And management of comorbid conditions can fall between the cracks in primary care and rehabilitation care.

Psychiatrists at UW Medicine introduced the idea of collaborative care in the 1990s to improve depression treatment in primary settings. The method is now gaining ground in areas where patients have multiple chronic medical conditions.

“That's why we're beginning to roll it out in other disability populations as well,” Bombardier said. “We've done other collaborative care studies that focused on managing chronic pain in people with multiple sclerosis and traumatic brain injury. We demonstrated positive outcomes, but the studies have not been published yet. We should be using this approach in any medical population that has multiple interacting comorbid chronic medical and mental health conditions.”

Bombardier said 61% of participants chose to focus on depression, 31% chose to focus on physical activity and 8% chose depression. Interestingly, researchers saw significant improvements in  depression and pain across the total sample.

“This highlights the fact that these conditions are interrelated and that treating one problem more proactively and in a more integrated manner can have a positive payoff for other secondary conditions,” Bombardier said. “Integrating medical and psychological care for those with chronic diseases can make a big difference for our patients and is something we should be implementing more in patients with these sorts of complex chronic health conditions.”

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