Integrated Community Collaborative Care for Seniors with Depression/Anxiety and any Physical Illness

Abstract

Background

We report on the feasibility and effectiveness of an integrated community collaborative care model in improving the health of seniors with depression/anxiety symptoms and chronic physical illness.

Methods

This community collaborative care model integrates geriatric medicine and geriatric psychiatry with care managers (CM) providing holistic initial and follow-up assessments, who use standardized rating scales to monitor treatment and provide psychotherapy (ENGAGE). The CM presents cases in a structured case review to a geriatrician and geriatric psychia­trist. Recommendations are communicated by the CM to the patient’s primary care provider.

Results

187 patients were evaluated. The average age was 80 years old. Two-thirds were experiencing moderate-to-severe depres­sion upon entry and this proportion decreased significantly to one-third at completion. Qualitative interviews with patients, family caregivers, team members, and referring physicians indicated that the program was well-received. Patients had on average six visits with the CM without the need to have a face-to-face meeting with a specialist.

Conclusion

The evaluation shows that the program is feasible and effect­ive as it was well received by patients and patient outcomes improved. Implementation in fee-for-service publicly funded health-care environments may be limited by the need for dedicated funding.