Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial

Jeffrey A Cully, Jessica Y Breland, Suzanne Robertson, Anne E Utech, Natalie Hundt, Mark E Kunik, Nancy J Petersen, Nicholas Masozera, Radha Rao, Aanand D Naik

Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices.