Evaluation of the Achieving Depression and Anxiety Patient Centered Treatment (ADAPT) Program
- Conditions
- DepressionAnxiety
- Interventions
- Behavioral: ADAPT
- Registration Number
- NCT04839718
- Lead Sponsor
- Kaiser Permanente
- Brief Summary
Depression and anxiety are increasingly common conditions for which primary care providers (PCPs) serve as the initial healthcare contact for most patients. Comorbid depression and anxiety result in higher costs, and treatment as usual, which is referrals to specialty psychiatric care, often contribute to delays in care. Collaborative psychiatric care is an evidence-based strategy to increase mental healthcare access while reducing costs. ADAPT is a novel collaborative care model. By using technology-driven appointments with providers, ADAPT increases access to mental healthcare, and reduces member wait times. This mixed methods study will assess implementation measures of the ADAPT program and the components of ADAPT related to patient mental health improvement compared to specialty mental health care. The hypothesis is that: ADAPT program will have good program reach and efficacy. We will examine program implementation and maintenance. Further, the study looks to uncover member and program characteristics that are associated with depression and anxiety remission and care utilization.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Adult Outcomes Questionnaire (AOQ) score between 10-30
- English-Speaking
- High risk for suicide defined by answer to question 9 on PHQ-9 of 1 or more
- Diagnosis of bipolar disorder
- Diagnosis of a psychotic disorder
- Dementia diagnosis
- Active substance use disorder diagnosis
- Current hospice
- Current home-based palliative care
- Residing in a skilled nursing facility
- Residing in an assisted living facility
- Non-Kaiser Permanente Member
- Established psychiatric care outside of Kaiser Permanente
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description ADAPT ADAPT ADAPT
- Primary Outcome Measures
Name Time Method Patient reach through study completion, 2 years Examine and compare patients eligible and enrolled in ADAPT versus those eligible but not enrolled in ADAPT
- Secondary Outcome Measures
Name Time Method Efficacy: Patient therapy engagement baseline, 3 and 6 months number of therapy contacts (individual, group and combined)
Efficacy: Patient time to care baseline, 3 and 6 months average time from ADAPT referral to first appointment with therapist or pharmacist
Efficacy: Anxiety outcomes baseline, 3 and 6 months Examine if patients enrolled in ADAPT demonstrate non-inferior anxiety outcomes defined by generalized anxiety disorder (GAD-2) score compared to treatment as usual.
Implementation: measurement-based care through study completion, 2 years Examine provider use of measurement-based care
Efficacy: Patient medication engagement baseline, 3 and 6 months medication length of treatment
Efficacy: Depression outcomes baseline, 3 and 6 months Examine if patients enrolled in ADAPT demonstrate non-inferior depression outcomes defined by change in the patient health questionnaire (PHQ-9) score compared to treatment as usual.
Efficacy: Time to clinical improvement baseline, 3 and 6 months Compare time to clinical improvement as defined by change in Adult Outcomes Questionnaire (AOQ score) from baseline to 3, and 6 months for members in ADAPT compared to treatment as usual.
Member characteristics associated with depression remission baseline, 3 and 6 months Clinical variables important to predicting intervention response: Patient demographics (age, sex, race/ethnicity, socioeconomic status), behavioral characteristics (exercise, sleep), and other individual characteristics (comorbidities, adverse childhood experiences, social supports, resilience).
Member characteristics associated with anxiety remission baseline, 3 and 6 months Clinical variables important to predicting intervention response: Patient demographics (age, sex, race/ethnicity, socioeconomic status), behavioral characteristics (exercise, sleep), and other individual characteristics (comorbidities, adverse childhood experiences, social supports, resilience).
Maintenance: Diagnosis through study completion, 2 years Examine provider use of a specific depression or anxiety diagnosis over time
Efficacy: Patient medication provider engagement baseline, 3 and 6 months number of clinical pharmacy contacts
Efficacy: Patient psychiatry engagement baseline, 3 and 6 months number of contact with psychiatrist
Implementation: Diagnosis through study completion, 2 years Examine provider use of a specific depression or anxiety diagnosis
Maintenance: Measurement-based care through study completion, 2 years Examine provider use of measurement-based care over time
Trial Locations
- Locations (1)
Kaiser Permanente Northern California Division of Research
🇺🇸Oakland, California, United States