Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Collaborative Care Program to Improve Treatment of Depression and Anxiety Disorders in Cardiac Patients (MOSAIC)
Brief Summary: For this trial, the investigators propose a prospective trial of a collaborative care program to identify and treat depression, generalized anxiety disorder, and panic disorder among patients admitted to the hospital for an acute cardiac illness (acute coronary syndrome, congestive heart failure, or arrhythmia). Such assessment and treatment for depression/generalized anxiety disorder/panic disorder will begin in the hospital, and ongoing management will continue for six months following discharge.

The investigators hypothesize that this model will lead to increased treatment rates, improved mood, reduced anxiety, and improved medical outcomes in this vulnerable population. If this model is effective, it could be implemented clinically to provide better and more complete care to patients hospitalized with acute cardiac illness, for whom depression and anxiety may be a risk factor for complications and death.

This will be a two-arm, single-blind randomized controlled trial, with one-half of patients randomized to collaborative care and one-half randomized to the control condition (usual care). Psychiatric treatment in the intervention arm will be provided in concert with patients' primary care physicians-with primary care physicians prescribing all medications-within a framework supervised by a psychiatrist.

The investigators will enroll patients who have any (or all) of the three included psychiatric diagnoses to improve the utility of the intervention. The investigators have chosen to enroll patients with several different cardiac diagnoses. This will allow the researchers to include patients with heterogeneous diagnoses and illness severity to determine if our intervention is effective in a broad population of patients with heart disease. The investigators will study an intervention targeting depression, generalized anxiety disorder, and panic disorder: all three disorders are disabling and associated with adverse cardiovascular outcomes, treatments for the conditions are highly similar, the investigators can treat patients who have more than one disorder, and a prior outpatient program successfully simultaneously addressed more than one mental health condition.

The project will involve: (1) screening patients for depression, generalized anxiety disorder, and panic disorder as part of usual clinical care, (2) evaluation of positive-screen patients by a study social work care manager, (3) a multicomponent in-hospital intervention (for collaborative care patients) that involves patient education, specialist-provided treatment recommendations, and a goal of in-hospital treatment initiation, and (4), after discharge, continued phone-based evaluation and care coordination with primary care physicians to provide stepwise treatment in the collaborative care arm. The intervention has been designed to be low-cost, low-burden, and easily generalizable to other settings.


Options:
A: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Behavioral: Psychotherapy, Other: Usual cardiological care | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Information session, Other: Usual cardiological care | Intervention Type: BEHAVIORAL; Name: Psychotherapy; Assigned to Arm(s): 1 | Intervention Type: BEHAVIORAL; Name: Information session; Assigned to Arm(s): 2 | Intervention Type: OTHER; Name: Usual cardiological care; Assigned to Arm(s): 1, 2
B: Arm Label: Comprehensive Intervention Group; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Lifestyle Changes, Drug: Antiplatelet Agents, Drug: Beta Blocker, Drug: ACE Inhibitors | Arm Label: Less Intensive Intervention Group; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Lifestyle Changes | Intervention Type: BEHAVIORAL; Name: Lifestyle Changes; Assigned to Arm(s): Comprehensive Intervention Group, Less Intensive Intervention Group | Intervention Type: DRUG; Name: Antiplatelet Agents; Assigned to Arm(s): Comprehensive Intervention Group | Intervention Type: DRUG; Name: Beta Blocker; Assigned to Arm(s): Comprehensive Intervention Group | Intervention Type: DRUG; Name: ACE Inhibitors; Assigned to Arm(s): Comprehensive Intervention Group
C: Arm Label: Collaborative care; Type: EXPERIMENTAL; Interventions: Other: Collaborative care | Arm Label: Usual care; Type: PLACEBO_COMPARATOR; Interventions: Other: Usual care | Intervention Type: OTHER; Name: Collaborative care; Assigned to Arm(s): Collaborative care | Intervention Type: OTHER; Name: Usual care; Assigned to Arm(s): Usual care
D: Arm Label: Depressed Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Psychoeducation; Treatment recommendations, Drug: Pharmacotherapy | Arm Label: Depressed Usual Care; Type: ACTIVE_COMPARATOR; Interventions: Other: Usual Care | Arm Label: Non-Depressed Control Group; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Psychoeducation; Treatment recommendations; Assigned to Arm(s): Depressed Intervention | Intervention Type: DRUG; Name: Pharmacotherapy; Assigned to Arm(s): Depressed Intervention | Intervention Type: OTHER; Name: Usual Care; Assigned to Arm(s): Depressed Usual Care

Answer: C