Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial.
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:
1Department of Psychiatry, Harvard Medical School, Boston, USA.
2Cambridge Health Alliance, Cambridge, USA.
3The Heller School for Social Policy and Management, Brandeis University, Waltham, USA.
4IBM Watson Health, Cambridge, USA.
5Department of Epidemiology, Brown University School of Public Health, Providence, USA.
6Department of Psychiatry, Harvard Medical School, Boston, USA. zschuman@cha.harvard.edu.
7Cambridge 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
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