A Real-World Pilot of the Collaborative Care Model for Adults With Cognitive Impairment and Neuropsychiatric Symptoms in Primary Care.

OBJECTIVE

The Collaborative Care Model, which integrates primary care, behavioral health, and structured care management, is a promising approach to improving outcomes for patients with cognitive impairment and neuropsychiatric symptoms. This study evaluated a pilot of Cognitive Impairment Collaborative Care (CICC) at a large urban academic medical center.

METHOD: Retrospective chart review of adults enrolled in the first year of the program (November 1, 2021 to October 31, 2022). CICC included assessments, biweekly telehealth visits, care management, psychiatric consultation, and therapy. The primary outcome was clinical effectiveness, defined as the change in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Secondary outcomes were adoption (number of clinicians referring), reach (patient enrollment), and implementation (number of encounters and psychiatric case reviews).

RESULTS

Twenty-two patients enrolled in CICC; all had depression or anxiety. About 5% of primary care clinicians referred an average of 1.6 patients (SD 1.7) in the first year. On average, patients were enrolled for 144.9 days (SD 79.7), had 2.3 encounters per month (SD 1.0), were case reviewed 8.6 times (SD 5.3), and 50% graduated in the first year. Patients exhibited significant reductions in depression (PHQ-9: mean change -4.7, SD 5.0, p = 0.003) and anxiety scores (GAD-7: mean change -4.3, SD 5.5, p = 0.01).

CONCLUSIONS

CICC achieved modest adoption and reach with demonstrated effectiveness in reducing depression and anxiety among patients with cognitive impairment.

RELEVANCE TO CLINICAL PRACTICE: Amid a shortage of geriatricians and geriatric psychiatrists in the U.S., collaborative care is a possible therapeutic option for the growing geriatric population.