12 Week Treatment Program for Mental Health in Lifestyle Medicine

by Katie Hill, MD · 2022

Significantly Reduced Depression, Anxiety, Insomnia in 12 Weeks

for patients with hypertension and atrial fibrillation

Background

Stress management and insomnia treatment are essential pillars of Lifestyle Medicine (LM)

Collaborative Care provides an evidence-based framework for treatment and reimbursement for both stress management and insomnia

We report descriptive, outcome, and financial data for stress management and insomnia treatment in a Medicare population in cardiology

Methods

Patient type

Cardiologist prescribed Medicare patients with hypertension & atrial fibrillation

Care delivery

Care was delivered by a care manager (Registered Nurse or Clinical Social Worker)

Care methods

Stress Management Pathway

  • Scales used: Patient Health Questionnaire-9 (PHQ-9), Anxiety Disorder-7 (GAD-7)
  • Treatment Modality: Behavioral activation for stress management and cognitive behavioral therapy skills coaching

Insomnia Pathway

  • Scales used: Insomnia Severity Index (ISI)
  • Treatment Modality: Insomnia skills coaching

Results

Depression
PHQ-9 | N=56

13.4PHQ-9

9.2PHQ-9

8.4PHQ-9

Anxiety
GAD-7 | N=35

12.9GAD-7

8.6GAD-7

7.0GAD-7

Insomnia
ISI | N=60

16.6ISI

11.1ISI

10.1 ISI

Average baseline scores for all patients treated for depression (N=152), anxiety (N=108), and insomnia (N=60) were in the mild range and after 12 weeks decreased to scores near “no disease” cutoffs

Depression, Anxiety, Insomnia: Depression scores decreased 31.4% (N=56), anxiety scores decreased 33.0% (N=35), and insomnia scores decreased 33.2% (N=60). At 12 weeks post intervention program, depression scores decreased 38.8%, anxiety scores decreased 44.4%, and insomnia scores decreased 41.0%

Financially, during one year of program implementation, one referring clinic with 16 physicians generated approximately one million dollars of additional revenue for the full Nudj Health Lifestyle Medicine treatment program

Adapting collaborative care to deliver lifestyle medicine within cardiology for stress management and insomnia significantly decreased symptoms in 12 weeks

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References

  1. Thaler RH, Sunstein CR Nudge: Improving Decisions about Health, Wealth, and Happiness. New York, NY: Penguin; 2009.
  2. Garrison GM, Angstman KB, O'Connor SS, Williams MD, Lineberry TW. Time to Remission for Depression with Collaborative Care Management (CCM) in Primary Care. J Am Board Fam Med. 2016 Jan-Feb;29(1):10-7. doi: 10.3122/jabfm.2016.01.150128. PMID: 26769872.
  3. Richmond LM. Payors Train PCPs to Treat Mental Health in House. Published Online: 30 Nov 2022. Accessed 20 Jul 2022. https://doi.org/10.1176/appi.pn.2021.11.4
  4. Reimbursement struggles for lifestyle medicine interventions pose significant barrier for health care practitioners, study finds. EurekAlert! News release. November 15, 2021. Accessed 20 Jul 2022. https://www.eurekalert.org/news-releases/934904.

*Conflict of interest: The authors are employees of Nudj Health and company stakeholders