Our patients with chronic diseases such as diabetes live with complex environmental, social, behavioral and emotional factors that contribute both to developing the disease (e.g. depression is a risk factor for developing diabetes) and to how they are self-managed. Too often guidelines for medical care of a particular chronic disease and guidance on psychosocial care are separate, often being provided to the patient by different care providers.

The American Diabetes Association (ADA) just issued the first psychosocial guideline for people with diabetes in the December issue of Diabetes Care (39:2126-2140). Key recommendations include:

• Psychosocial care should be integrated with medical care with goal setting targeted on optimizing both health outcomes and health-related quality of life

• Regular (initial, periodic) assessment of distress, depression, anxiety, eating disorders and cognitive disorders should be conducted with standardized and validated assessment tools

• Consideration of burden of treatment and patient levels of self-efficacy when making treatment recommendations.

• Behavioral health providers should be identified and alliances formed for the co-management of people with diabetes

• Life considerations such as pregnancy and sexual functioning should be considered when formulating treatment plans.

Multiple other syndrome specific recommendations were incorporated into the guideline. Although these guidelines focused on diabetes psychosocial care, many of the recommendations pertain to many chronic diseases such as COPD, heart failure, asthma, and arthritis.  There has been considerable work over the past decade on strategies for addressing and improving these psychosocial components of care, best illustrated in the design and training for the  Chronic Disease Self-Management Program developed by Kate Lorig at Stanford University (http://patienteducation.stanford.edu/programs/cdsmp.html) which focuses on skill building in self-efficacy not only of clinical care but also in life management (living with chronic disease).

As you work on improving the strategies and protocols for chronic disease in your practice, consider integration psychosocial interventions into your practice, and getting to know the behavorial practitioners in your community