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

Trillium Health Centre

Status: Completed

Conditions: Depression; Anxiety

Treatments: Behavioral: Mood Consultation; Behavioral: Collaborative Care Model

Study type: Observational

Funder types: Other

Identifiers

NCT03617614

TrilliumHC

Details and patient eligibility

About

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.

Full 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.

Enrollment: 13 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

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

Trial design

13 participants in 2 patient groups

Collaborative Care Model

Description:

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

Treatment:

Behavioral: Collaborative Care Model

Mood Consult

Description:

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

Treatment:

Behavioral: Mood Consultation