Feature

Psychological research has demonstrated the health benefits and cost-effectiveness of managing stress. And now Congress has ordered a new, larger-scale demonstration project to confirm these findings among the elderly.

Armed with the results from a pioneering study, conducted by researchers at APA and Duke University Medical Center, the APA Practice Organization convinced Congress to direct further research. The original study, which was led by psychologist James Blumenthal, PhD, and colleagues at Duke and published in the Jan. 15, 2002, issue of The American Journal of Cardiology (Vol 90, No. 1), found that cardiac patients who are taught to manage their stress enjoy better health at less cost to the health system and themselves than patients who participate in an exercise program or those given typical heart care, such as medications and monitoring.

The APA Practice Organization secured the inclusion of the demonstration project in the fiscal year 2004 Omnibus Appropriations Act, which became law in January. Specifically, this initiative directs the federal Centers for Medicare and Medicaid Services (CMS) to study the benefits of psychological interventions in the treatment of heart disease.

"This significant development reflects policy-makers' growing recognition of the value of psychological services and the need to integrate these services with physical health care," says Russ Newman, PhD, JD, APA executive director for professional practice. "We look forward to project results that will help further demonstrate this value." Newman also commended Sen. Arlen Specter (R-Pa.) for his leadership in pushing the psychology project.

Positive directions

In fact, in directing CMS to conduct a study of the cost-savings and quality-of-care benefits from psychological interventions in the treatment of Medicare beneficiaries with cardiovascular disease, Congress specifically referenced the Duke study's findings. Under the new law, the Bush Administration must conduct the study, says Elizabeth Cullen, JD, MPA, director of congressional affairs for the APA Practice Organization.

Replicating good results

Funding for the study may come from CMS, or CMS might work with the National Heart, Lung and Blood Institute or the U.S. Centers for Disease Control and Prevention to implement the study, adds Cullen.

And APA has a good idea of how to structure the study. "Our goal is to have the demonstration build upon the findings of the Duke study," says Cullen. Indeed, the Duke study found that during the first year, the average cost for patients who were taught stress management was $920 per patient, compared with $2,388 per patient for those who took part in an exercise group and $4,127 for those who were given standard cardiac care.

After five years, the stress management group averaged only 0.8 additional cardiac events--angioplasty, heart attack, bypass surgery or death--each, while the standard care group had 1.3 such events per patient.

APA plans to remain involved to help get the demonstration project off the ground, adds Cullen.