Author: Gawande R1,2, To MN2, Pine E2, Griswold T1,2, Creedon TB3,4, Brunel A2, Lozada A2, Loucks EB5, Schuman-Olivier Z6,7
Affiliation: <sup>1</sup>Department of Psychiatry, Harvard Medical School, Boston, USA.
<sup>2</sup>Cambridge Health Alliance, Cambridge, USA.
<sup>3</sup>The Heller School for Social Policy and Management, Brandeis University, Waltham, USA.
<sup>4</sup>IBM Watson Health, Cambridge, USA.
<sup>5</sup>Department of Epidemiology, Brown University School of Public Health, Providence, USA.
<sup>6</sup>Department of Psychiatry, Harvard Medical School, Boston, USA. zschuman@cha.harvard.edu.
<sup>7</sup>Cambridge Health Alliance, Cambridge, USA. zschuman@cha.harvard.edu.
Conference/Journal: J Gen Intern Med.
Date published: 2018 Dec 3
Other:
Special Notes: doi: 10.1007/s11606-018-4739-5. [Epub ahead of print] , Word Count: 297
BACKGROUND: Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources.
OBJECTIVE: Mindfulness Training for Primary Care (MTPC) is an 8-week, referral-based, insurance-reimbursable program integrated into safety-net health system patient-centered medical homes. We hypothesized that MTPC would be more effective for catalyzing chronic disease self-management action plan initiation within 2 weeks, versus a low-dose comparator (LDC) consisting of a 60-min mindfulness introduction, referral to community and digital resources, and addition to a 6-month waitlist for MTPC.
PARTICIPANTS: Primary care providers (PCPs) and mental health clinicians referred 465 patients over 12 months. All participants had a DSM-V diagnosis.
DESIGN AND INTERVENTIONS: Participants (N = 136) were randomized in a 2:1 allocation to MTPC (n = 92) or LDC (n = 44) in a randomized controlled comparative effectiveness trial. MTPC incorporates mindfulness, self-compassion, and mindfulness-oriented behavior change skills and is delivered as insurance-reimbursable visits within primary care. Participants took part in a chronic disease self-management action planning protocol at week 7.
MAIN MEASURES: Level of self-reported action plan initiation on the action plan initiation survey by week 9.
KEY RESULTS: Participants randomized to MTPC, relative to LDC, had significantly higher adjusted odds of self-management action plan initiation in an intention-to-treat analysis (OR = 2.28; 95% CI = 1.02 to 5.06, p = 0.025).
CONCLUSIONS: An 8-week dose of mindfulness training is more effective than a low-dose mindfulness comparator in facilitating chronic disease self-management behavior change among primary care patients.
KEYWORDS: health behavior; mindfulness; patient-centered; primary care; self-management; self-regulation
PMID: 30511291 DOI: 10.1007/s11606-018-4739-5