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18-03-2019 | ORIGINAL PAPER | Uitgave 9/2019

Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial

Tijdschrift:: Mindfulness > Uitgave 9/2019

Auteurs:: Richa Gawande, Elizabeth Pine, Todd Griswold, Timothy Creedon, Zayda Vallejo, Elana Rosenbaum, Angela Lozada, Zev Schuman-Olivier

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Electronic supplementary material

The online version of this article (https://doi.org/10.1007/s12671-019-01116-8) contains supplementary material, which is available to authorized users.

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Abstract

Objectives

Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential.

Methods

We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness self-management. Participants scheduled a PCP visit to co-create a self-management action plan during week 6.

Results

Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing self-management behavior change through action plan initiation (OR=4.34, p=0.03).

Conclusions

MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.

Clinical Trials Registration Number: NCT02972203

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Titel: Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial
Auteurs:: Richa Gawande
Elizabeth Pine
Todd Griswold
Timothy Creedon
Zayda Vallejo
Elana Rosenbaum
Angela Lozada
Zev Schuman-Olivier
Publicatiedatum: 18-03-2019
DOI: https://doi.org/10.1007/s12671-019-01116-8
Uitgeverij: Springer US
Tijdschrift: Mindfulness
Uitgave 9/2019
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535

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Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial

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