Eric Franco

Date of Submission

2018

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Robert A DiTomasso, PhD, ABPP

First Advisor

Robert A. DiTomasso, PhD, ABPP

Second Advisor

Barbara A. Golden, PsyD, ABPP

Third Advisor

Harry J. Morris, DO, MPH, CPE, FACOFP

Abstract

As the health care system continues to evolve, the challenges related to successfully treating chronic conditions persist. To address these challenges, supplemental treatments, such as the shared medical appointment (SMA) and behavioral health care (BHC), have been implemented to provide patients with additional levels of psychoeducation and support in addition to treatment by their physician. The total sample used in this study was 118. The purpose of this study was to evaluate the effectiveness of integrated primary care (IPC), IPC plus SMA, and IPC plus BHC to determine if supplemental treatment combined with IPC produced greater improvement in patients with diabetes. The measures in this study were body mass index (BMI), systolic blood pressure, diastolic blood pressure, hemoglobin A1C (HbA1c), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and total cholesterol. To test this hypothesis, a 3 x 2 analysis of variance with repeated measures on one factor was conducted. The independent variable had three levels describing the treatment type (integrated primary care (IPC), IPC plus SMA, and IPC plus behavioral health). Outcome measures were examined at pre and posttest to determine if the conditions considered to be more integrated showed stronger treatment effects as measured by the outcome variables. Results indicated that none of the seven outcome variables showed significant improvement as a result of receiving a supplemental level of care in addition to IPC. However, four of the seven variables improved over time regardless of treatment condition. This finding suggests that perhaps the addition of SMA and BHC did not add anything over and above IPC only. Careful consideration should be applied to these results, because these particular patients were treated according to the IPC model. Therefore, physicians may have actually been providing patients with similar interventions across conditions, such as psychoeducation and motivational interviewing, during their routine doctor visits. Thus, patients who received IPC may have actually received components included in the other two groups.

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