Clinical trial NCT03617614: Evaluation of the Medical Psychiatry Alliance Senior's Outpatient Collaborative Care Project
Official title: Evaluation of the Medical Psychiatry Alliance Senior's Outpatient Collaborative Care Project
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Anxiety
Depression
Lead sponsor: Trillium Health Centre
Sponsor class: OTHER
Collaborators: name: Centre for Addiction and Mental Health
name: Medical Psychiatry Alliance
First posted: 2018-08-06
Enrollment: 13
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Seniors discharged from the Medical Psychiatry Alliance Senior Outpatient Program or Seniors that received a one time mood consultation at CAMH

Brief summary: This study evaluates the effectiveness of a collaborative care model designed to treat frail seniors with both a mental (anxiety and/or depression) and a physical health condition impacting function with a comparison group that receives a psychiatric mood consult and a letter of recommendation but who are mainly cared for by their PCP.

Detailed description: Literature suggests seniors with co-existing mental and physical health concerns encounter challenges with accessing care including limited availability of geriatric specialists, inadequate navigational support, disjointed communication, and limited provider knowledge/ capacity to manage these complex patients. In conjunction with primary care, a new program was created to assist in addressing these concerns. A novel collaborative care model was developed integrating Geriatric Medicine and Geriatric Psychiatry anchored in primary care, where primary care remains the most responsible provider. Care managers (CMs) work with seniors in the community, for up to 16 weeks, who have at least one chronic health condition affecting function and depressed mood and/or anxiety. The care model focusses on 4 main components: integrated therapeutic care management, systematic case reviews (SCRs), integrated care planning, and education/capacity building. CMs provide comprehensive assessments, system navigation, monitoring using symptom rating scales, and a problem solving psychotherapy for seniors using reward exposure to form action plans (ENGAGE). CMs present cases weekly at SCRs, where the team includes a geriatrician, geriatric psychiatrist, primary care, and allied health. Recommendations are made then sent to the PCP for implementation. In the current evaluation study we will compare levels of depression, anxiety and functioning of seniors receiving the collaborative care model with those receiving a one time mood consultation.

Eligibility criteria: Inclusion Criteria:

* Depressive mood PHQ-9 \>9 or anxiety GAD-7 \>9
* One or more chronic medical condition(s) impacting function
* Had a one time mood consultation at CAMH or has been a patient in the Medical Psychiatry Alliance Senior Outpatient Program
* Able to speak English

Exclusion Criteria:

* Moderate to severe cognitive decline
* Positive psychotic symptoms
* Active suicidal ideation or attempt within the last year
* Psychiatric admission within the last year

Primary outcomes:
measure: Change in Patient Health Questionnaire (PHQ-9) from baseline to 12 months after discharge
timeFrame: Baseline to 12 months after discharge
Secondary outcomes:
measure: Change in Generalized Anxiety Disorder 7-item (GAD-7) from baseline to 12 months
timeFrame: Baseline to 12 months after discharge
measure: Change in World Health Organization Disability Assessment Schedule 2.0 (WHODAS) from baseline to 12 months
timeFrame: Baseline to 12 months after discharge
measure: Patient satisfaction with care
timeFrame: 12 months after discharge
measure: Healthcare Utilization in the previous 3 months
timeFrame: 12 months after discharge
Other outcomes:
Locations:
city: Mississauga
country: Canada
facility: Trillium Health Partners
state: Ontario
city: Toronto
country: Canada
facility: Centre for Addiction and Mental Health
state: Ontario
Study officials:
affiliation: Trillium Health Partners
name: Judith Versloot, PhD
role: PRINCIPAL_INVESTIGATOR
References: