Community Assets Supporting Transitions (CAST)

Not Applicable

Completed

• Conditions: Depressive Symptoms; Comorbidity
• Interventions: Behavioral: Intervention group (CAST)

• Registration Number: NCT03157999
• Lead Sponsor: McMaster University

Brief Summary

The aim of this study is to test a support program for older adults with symptoms of depression and other chronic health problems after they are discharged home from hospital. The study will be conducted in three communities in Ontario (Sudbury, Burlington, and Hamilton) and the program will be implemented with input from community members. The program will be delivered by a Registered Nurse, who will provide support to patients via home visits and telephone calls. The nurse's role will involve linking patients and their caregivers with needed services and supports, reviewing medications that the patients are taking, assessing patients' health, building the skills of patients in problem-solving and managing their care, and providing education to patients and their caregivers.

Detailed Description

Implementing transitional care interventions for older adults with depressive symptoms and multiple chronic conditions (MCC) is a pressing concern since older adults with depression face persistent health disparities. The Community Assets Supporting Transitions (CAST) research team seeks to address these health inequities, and improve health outcomes in this vulnerable and under-served population by developing and implementing an intervention that will improve patients' self-management ability, support their families and caregivers, and build capacity for primary care and other health and non-health providers to collaborate in delivering home and community services. The proposed study builds on our pilot study that evaluated a nurse-led intervention for older adult home care clients with MCC and depressive symptoms and demonstrated that the intervention was feasible and effective in reducing depressive symptoms.

The overall aim of the study is to improve care transitions in older adults with MCC and depressive symptoms. The project will address three research questions:

1. What is the effect of a new, nurse-led hospital-to-home transitional care intervention compared to usual care on health outcomes and costs for older adults with MCC and depressive symptoms?

2. How is a care transition intervention adapted and implemented in diverse settings?

3. What is required to sustain and scale up the intervention? We hypothesize that the intervention will improve health outcomes and reduce use of expensive health services compared to usual care at no additional cost, from a societal perspective.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2017-04-12
• Study First Submitted QC: 2017-05-16
• Study First Posted: 2017-05-17
• Study Start: 2017-07-25
• Primary Completion: 2020-06-15
• Study Completion: 2020-06-15
• Status Verified: 2023-03
• Last Update Submitted: 2023-03-21
• Last Update Posted: 2023-03-23

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 127

Inclusion Criteria

• Is an adult, age 65 or older;
• Is planned for discharge from hospital to the community (this includes retirement homes and transitional care beds);
• Self-reports having a diagnosis of at least two chronic conditions;
• Is experiencing depressive symptoms, assessed using the 2-item version of the Patient Health Questionnaire (PHQ-2);
• Lives within one of the study regions (Sudbury, Burlington, or Hamilton), and is not planning to move out of the region during the trial (defined as a one-year period);
• Is capable of providing informed consent, or has a substitute decision-maker who is able to provide informed consent on his/her behalf; and
• Is competent in English, or has an interpreter who is competent in English.

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Exclusion Criteria

• Is being discharged from the hospital to a long-term care home or tertiary care.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention group (CAST)	Intervention group (CAST)	Participants in the intervention group will receive the CAST hospital-to-home transition intervention in addition to usual care.

Primary Outcome Measures

Name	Time	Method
Change in mental functioning of the older adult study participant	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	Measured by the mental component summary (MCS) score of the Veterans RAND 12 item Health Survey (VR-12).

Secondary Outcome Measures

Name	Time	Method
Change in health-related quality of life of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	Measured by the Veterans RAND 12 item Health Survey (VR-12).
Change in depressive symptoms of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	As measured by the CESD-10 to determine the presence and severity of depressive symptoms.
Change in utilization of health and social services by the: 1) older adult study participant, 2) family/friend caregiver of the older adult study participant.	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	As measured by the Health and Social Services Utilization Inventory
Change in mental functioning of the family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	Measured by the mental component summary (MCS) score of the Veterans RAND 12 item Health Survey (VR-12).
Change in physical function of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	Measured by the physical component summary (PCS) score of the Veterans RAND 12 item Health Survey (VR-12).
Change in unmet care needs of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization	As measured through the Unmet Care Needs questionnaire (developed using input from patient/caregiver co-researchers to ensure the inclusion of outcomes that are relevant and meaningful to patients and caregivers).
Change in anxiety of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization	As measured by the GAD-7 (24).
Change in caregiver strain of the family/friend caregiver of the older adult study participant (if applicable)	T1 = Baseline data collection; TT2 = 6 months after randomization; T3 = 12 months after randomization	As measured by the Modified Caregiver Strain Index
Change in utilization of health services by the older adult study participant	T2 = 6 months after randomization; T3 = 12 months after randomization	As identified through Institute for Clinical Evaluative Sciences (ICES) databases
Change in patient-reported experience (CCCQ) for the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization	As measured through the adapted Client-Centred Care Questionnaired (CCCQ).
Change in patient-provider communication of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization	As measured through the Patient-Provider Communication (PCC) questionnaire.
Change in patient-reported experience (IC-PREMs) for the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	T1 = Baseline data collection; T2 = 6 months after randomization	As measured through the adapted Integrated Care Patient-Reported Experience Measures (IC-PREMs).

Trial Locations

Locations (4)

Joseph Brant Hospital; 🇨🇦 Burlington, Ontario, Canada

Hamilton General Hospital; 🇨🇦 Hamilton, Ontario, Canada

School of Nursing, McMaster University; 🇨🇦 Hamilton, Ontario, Canada

Health Sciences North/Laurentian University; 🇨🇦 Sudbury, Ontario, Canada