Evaluation of the Medical Psychiatry Alliance Senior's Outpatient Collaborative Care Project
- Conditions
- DepressionAnxiety
- Interventions
- Behavioral: Mood ConsultationBehavioral: Collaborative Care Model
- Registration Number
- NCT03617614
- Lead Sponsor
- Trillium Health Centre
- 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 13
- 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
- Moderate to severe cognitive decline
- Positive psychotic symptoms
- Active suicidal ideation or attempt within the last year
- Psychiatric admission within the last year
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Mood Consult Mood Consultation Participants who received a one time mood consultation at the Centre for Addiction and Mental Health. Collaborative Care Model Collaborative Care Model Participants who received care from the Medical Psychiatry Alliance Seniors Outpatient Collaborative Care Program at Trillium Health Partners.
- Primary Outcome Measures
Name Time Method Change in Patient Health Questionnaire (PHQ-9) from baseline to 12 months after discharge Baseline to 12 months after discharge The Patient Health Questionnaire (PHQ-9) is a 9-item questionnaire that is used for screening, diagnosing, monitoring, and measuring the severity of depression. Each item can be answered on a 4 point scale running from 0= 'not at all' to 3= 'nearly every day'. The total score ranges from 0-27 where 0 is no depression and 27 is severe depression.
- Secondary Outcome Measures
Name Time Method Change in Generalized Anxiety Disorder 7-item (GAD-7) from baseline to 12 months Baseline to 12 months after discharge The Generalized Anxiety Disorder 7-item (GAD-7) is a 7-item questionnaire that is used for screening, diagnosing, monitoring, and measuring the severity of anxiety. Each item can be answered on a 4 point scale running from 0= 'not at all sure' to 3= 'nearly every day'. The total score ranges from 0-21 where 0 is no anxiety and 27 is severe anxiety.
Patient satisfaction with care 12 months after discharge The question that will be asked is: 1) I think the services provided at CAMH/THP were of high quality. The answer category is a 5-point likert rating scale running form 5=strongly agree to 0=strongly disagree. Score range 0= not at all satisfied to 5= very satisfied.
Change in World Health Organization Disability Assessment Schedule 2.0 (WHODAS) from baseline to 12 months Baseline to 12 months after discharge The WHODAS is a practical generic assessment instrument that is used to measure health and disability. The WHODAS captures level of functioning in six domains: cognition, mobility, self-care, getting along and life activities. The 12-item questionnaire version asks about difficulties due to patient health conditions. Patients answer 12 questions within the 6 domains and select the best option of 5 answer categories: 1=none, 2=mild, 3=moderate, 4=severe, 5=extreme or cannot do. The total sum of the questions range between 12-60. and is than divided by 12 to determine where the patient falls on "none to extreme or cannot do" (range 1-5) scale .
Healthcare Utilization in the previous 3 months 12 months after discharge The participants will be asked 6 questions about if the participant has seen a family physician, social worker, psychiatrist, psychologist and/or visited the emergency department and/or has been admitted to the hospital in the past 3 months. The number of health care providers seen will be summed to a total score that ranges from 0-6 where 0 represents no health care utilization and 6 represent high healthcare utilization.
Trial Locations
- Locations (2)
Trillium Health Partners
🇨🇦Mississauga, Ontario, Canada
Centre for Addiction and Mental Health
🇨🇦Toronto, Ontario, Canada