Telephone‐based care management for older adults initiated on psychotropic medication

Abstract

Objective Explore the longitudinal, six-month symptom course of older adults newly started on an antidepressant or anxiolytic by non-psychiatrist physicians and enrolled in a care management program. Method Naturalistic cohort study of older adults (age ≥65 years) receiving pharmacotherapy and telephone care management. Participants are non-institutionalized adults participating in Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly who completed telephone-based clinical assessments including demographic data, self-report on history of psychiatric treatment and adherence, and standardized symptom scales. Results 162 participants with an average age of 77.2 years (SD 6.8) were followed and, for analysis, split into two groups by PHQ-9 score: 75 (46.3%) scoring 0–4 (minimally symptomatic group, MSG) and 87 (53.7%) ≥5 (symptomatic group, SG). Over 6 months, the SG improved with PHQ-9 scores beginning on average at 10.0 (SD 4.6) and falling to 5.4 (SD 4.2) (F(1, 86)=29.53, p <0.0001). The MSG had no significant change in depressive symptoms. Emotional health as measured by SF-12 Mental Composite Score mirrored the PHQ-9 change and lack thereof in the SG and MSG, respectively. No clinical or demographic features were associated with symptom improvement in the SG, though they were more likely to report medication adherence (66.7% v. 44.0%, χ 2(1)=8.4, p=0.0037) compared with the MSG. Conclusions Participation of symptomatic older adults initiated on psychotropic medication in a telephone care management program was associated with improvement in depressive symptoms and overall emotional well-being, notable findings given participants’ advanced age, state-wide distribution, and history of limited utilization of mental health care.

Telephone‐based management of chronic pain in older adults in an integrated care program

“…Telephone‐based interventions for chronic pain may reach those who may have barriers to care or are otherwise not seeking treatment. Improvement in mental health symptoms and alcohol dependence through care management has prompted consideration of using such a care model for other chronic disorders; results from the current study suggest that the model may be successfully applied to older adults with a complex chronic condition such as chronic pain. Taken together, our evidence suggests that telephone PCM may reduce disability from chronic pain in older patients and warrants further study in this population.…”

A Telephone-Based Program to Provide Symptom Monitoring Alone vs Symptom Monitoring Plus Care Management for Late-Life Depression and Anxiety

“…An overview of the procedures and components of the overall SUSTAIN program (formerly named the PACE/PACENET Behavioral Health Laboratory program) has been published elsewhere. 29,30 The full trial protocol and an outline of the clinical procedures are provided in Supplement 1. Clinical staff received extensive training, and fidelity to the intervention was ensured via weekly supervision with the medical director (J.E.S.)…”

“…The SUSTAIN program provides clinical MH CM services to low-income older adults enrolled in the state of Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE)/Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier (PACENET) pharmacological assistance program who are newly prescribed a psychotropic medication, as well as to their primary care providers. 29,30 Program features include (1) case finding and enrollment of older adults from a diverse community sample; (2) standardized, measurement-based, software-aided MH assessment and symptom monitoring that can be delivered by telephone and is thus available to primary care practices regardless of location, size, or resources; and (3) CM, which includes both connection to local community agencies and services and brief therapies for a wide variety of behavior symptoms and disorders (eg, depression, anxiety, and at-risk drinking). We hypothesized that, compared with individuals randomized to receive MH symptom MA (hereafter the MA arm), those randomized to receive MH symptom monitoring plus CM (hereafter the CM arm) would demonstrate more favorable clinical outcomes, including better overall MH functioning (primary outcome) and fewer depressive and anxiety symptoms.…”

Older adults recently started on psychotropic medication: where are the symptoms?

“…These analyses are based on an ongoing clinical program. The data collection methods that follow are similar to those described in previous publications (Maust et al, 2011(Maust et al, , 2013a.…”