Pointing the way to health
Adjusting to the hardships of diabetes and cardiovascular disease can be difficult, but managing these chronic conditions while dealing with depression takes teamwork.
That’s the idea behind COMPASS (care of mental, physical and substance-use syndromes), a collaborative care model that partners patients and primary care doctors with a team of experts to address the twofold punch of chronic disease and depression — which affects up to 15 percent of people with diabetes and heart disease.
COMPASS is different from the usual care model because it means more frequent communication between the patient and doctors, said Sharon Learned, nurse care coordinator with Mayo Clinic Health System in Red Wing. The facility is part of a group of clinics implementing the program nationwide.
“(The patient’s) primary doctor keeps in contact with a care coordinator either weekly or monthly between visits,” Learned explained. “So we’re able to tweak things sooner than if patients just came to see their doctor at intervals.”
Learned said she meets every Friday with two participating COMPASS physicians — a medical doctor and a psychiatrist — to review the condition of patients in the program. The team then makes recommendations to primary doctors, who have the final say on what treatments to order.
“It makes you aware that you need to take care of yourself,” said Cindy Becker of Hager City, a 15-year diabetic and the first patient to sign up for the program locally. In less than a year, she said COMPASS has helped treat her depression and get her blood sugar under control.
“I wasn’t doing a good job taking care of myself,” Becker said. “Having this team, I had more people helping me to be able to succeed.”
Becker said she also has struggled with depression since 2005, and that the hopelessness brought on by the mental illness made treating her diabetes difficult. “You just kind of quit caring.”
“Diabetes is a lot of work, and when it’s not going well, it can feel overwhelming,” said Dr. Mansi Kanuga, Becker’s primary care provider.
“And it compounds,” Becker added. “You don’t take care of yourself when you’re depressed, then your blood sugar numbers get all messed up and you get more depressed. It’s just this big circle that keeps on rolling.”
After Kanuga referred her to the COMPASS program, Becker said she started having weekly phone calls with Learned. Their conversations were used to help adjust medication for her depression and set goals such as checking blood sugar after every meal and being more physically active.
COMPASS started as a study for Medicare and Medicaid patients by the Institute for Clinical Systems Improvement, a non-profit healthcare advancement group. Its research found that while a majority of patients with depression will see a primary care provider, it’s only spotted about half of the time.
“By addressing mental and physical chronic diseases with the COMPASS model, the physician will more readily identify patients with depression or risky substance use,” the organization says.
Mayo Clinic Health System in Red Wing has had 53 patients participate in COMPASS since last April, Learned said, adding that the program now is offered to all patients regardless of insurance provider.
She said anyone interested in the program should speak with their doctor to learn more and decide if it’s right for them.