Evaluation of the Medical Psychiatry Alliance Senior's Outpatient Collaborative Care Project

NCT03617614 | Completed

• 1 other identifier: TrilliumHC
• Study Type: observational
• Target: 13
• Locations: 1 country
• Sites: 2

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.

Conditions

Anxiety; Depression

Outcome Measures

Primary Outcomes (1)

• Change in Patient Health Questionnaire (PHQ-9) from 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.

  Baseline to 12 months after discharge

Secondary Outcomes (4)

• Change in Generalized Anxiety Disorder 7-item (GAD-7) from baseline to 12 months

  Baseline to 12 months after discharge

• Change in World Health Organization Disability Assessment Schedule 2.0 (WHODAS) from baseline to 12 months

  Baseline to 12 months after discharge

• Patient satisfaction with care

  12 months after discharge

• Healthcare Utilization in the previous 3 months

  12 months after discharge

Study Arms (2)

Collaborative Care Model

Participants who received care from the Medical Psychiatry Alliance Seniors Outpatient Collaborative Care Program at Trillium Health Partners.

Behavioral: Collaborative Care Model

Mood Consult

Participants who received a one time mood consultation at the Centre for Addiction and Mental Health.

Behavioral: Mood Consultation

Interventions

Collaborative Care Model BEHAVIORAL

Trained care managers (CM) work collaboratively with patients, caregivers, and primary care providers to provide education, care navigation and behavioral activation. The latter includes a stepped psychotherapy intervention called ENGAGE, that focuses on "reward exposure" engagement in meaningful, rewarding activities for patients. Patients (home) visits are delivered over a period of 6 to 16 weeks. Progress is assessed with standardized measures for depression (PHQ-9), anxiety (GAD-7) and functioning (WHO-DAS). Furthermore, patients are presented by the CM at Systematic Case Review meetings where an integrated team of medical, psychiatric and allied health professionals work collaboratively to review the patient's goals and treatment to formulate a care plan and recommendations.

Also known as: ENGAGE

Collaborative Care Model

Mood Consultation BEHAVIORAL

A meeting with a psychiatrist to do assessment, provide education and make recommendations regarding the care of the patient for the Primary Care Provider.

Mood Consult

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• 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

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• Trillium Health Centre: lead
• Centre for Addiction and Mental Health: collaborator
• Medical Psychiatry Alliance: collaborator

Study Sites (2)

Trillium Health Partners

Mississauga, Ontario, L5B 1B8, Canada

Location

Centre for Addiction and Mental Health

Toronto, Ontario, M6J 1H4, Canada

Location

MeSH Terms

Conditions

Anxiety Disorders; Depression

Interventions

engage 8200

Condition Hierarchy (Ancestors)

Mental Disorders; Behavioral Symptoms; Behavior

Study Officials

• Judith Versloot, PhD

  Trillium Health Partners

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Lead (PhD)

Study Record Dates

• First Submitted: July 19, 2018
• First Posted: August 6, 2018
• Study Start: July 1, 2018
• Primary Completion: January 1, 2020
• Study Completion: June 1, 2020
• Last Updated: March 22, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (2)