Commonly Comorbid: Diabetes and Behavioral Health Disorders

In 2017 the United States spent more than $3 trillion on healthcare, yet Americans have poorer overall health compared to other countries. In the United States, a clinician diagnoses a patient with diabetes, a high-risk condition needing many healthcare resources, every 21 seconds.

The Institute for Healthcare Improvement has proposed 'Triple Aim' goals to combat rising healthcare costs, improve the health of populations, and improve patients' care experiences. Additionally, healthcare is moving away from fee-for-service and toward value-based care, meaning provider reimbursement is based on patient outcomes. The Triple Aim goals, in conjunction with value-based reforms, have resulted in the development of better coordinated primary care models, such as high-risk patient-centered medical homes.

The Drug and Alcohol Dependence journal published a study finding a major gap in primary care coordination, noting 82% of diabetic patients also had behavioral health disorders (BHDs). Few studies of BHDs, like substance use disorder (SUD), exist in high-risk diabetic patients. Regardless, overwhelming evidence proves increasing number of comorbidities correlates with higher healthcare costs, and poorer patient outcomes.

Healthcare professionals, and reformers must work together to develop and implement comprehensive care models that integrate mental health services for high risk patients who have diabetes.

Pharmacists have an important role in screening for BHDs in patients with high-risk conditions, including diabetes. Inappropriate medication adherence raises red flags for potential BHDs, and inadequate patient education, both common in these complex patients. Pharmacists can screen with tools like SBIRT (Screening, Brief Intervention. and Referral to Treatment) to target patients with psychological barriers to adherence and recommend treatment. Nevertheless, to optimize patient care, pharmacists should notify providers of any nonadherence in high-risk patients for further behavioral health evaluation.

Treatment of BHDs, especially SUD, is not as accessible as other treatment. Under the Controlled Substance Act, providers must train and qualify for a waiver to prescribe evidence-based treatments for SUD. These treatment providers, and all mental health services, must be more accessible for patients to improve population health.

Sara Miller is a 2019 PharmD candidate at the University of Connecticut in Storrs, CT.

References

Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/. Accessed June 18, 2018.

The Institute for Healthcare Improvement. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed June 18, 2018.