Impact of Integrated Care Pathways Within the Framework of Collaborative Care on Older Adults With Anxiety, Depression, or Mild Cognitive Impairment
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ObjectivesTo evaluate the impact of an Integrated Care Pathway (ICP) within a collaborative care framework for anxiety, depression and mild cognitive impairment (MCI) on clinical outcomes, quality of life, and time to treatment initiation.
DesignProspective Cohort study.
SettingPrimary care practices in Toronto and Hamilton, Ontario, Canada.
ParticipantsPatients of participating primary care practices born in the years 1950 to 1958.
Sample sizeTarget 150 participants, 75 in ICP and 75 in Treatment-As-Usual (TAU) arm.
InterventionICP within a collaborative care framework and TAU.
Methods and resultsOne hundred forty-five participants with anxiety, depression or MCI, from five primary care practices were enrolled: 69 were managed as per ICP and 76 as per TAU. All underwent outcome assessments at 6, 12, 18, and 24 months. Compared to TAU, ICP participants had a significantly higher rate of improvement in depression symptoms (β = -0.620, F (1, 256) = 4.10, p = 0.044), anxiety symptoms (β = -0.593, F (1, 223) = 4.00, p = 0.047), and quality of life (β = 1.351, F(1, 358) = 6.58, p = 0.011). The ICP group had also a significantly higher "hazard" of treatment initiation (HR = 3.557; 95% CI: [2.228, 5.678]; p < 0.001) after controlling for age, gender and baseline severity of symptoms compared to TAU group.
ConclusionsUse of an ICP within a collaborative care framework in primary care settings for anxiety, depression and MCI among older adults, results in faster reductions in clinical symptoms and improvement in quality of life compared to usual care, as well as faster access to recommended treatments.
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