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