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

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.