Patient and Family Caregiver Experience with a Collaborative Care Pilot Project to Support Seniors Managing Multi-Morbidity in a Primary Care Setting
Publication: Canadian Journal of Community Mental Health
5 April 2021
Abstract
This study reports findings from an evaluation of a 3-year collaborative care pilot project implemented in a Canadian primary care setting to assess and treat seniors (age ≥ 65) living at home with a chronic physical illness and co-morbid depressed mood or anxiety. Data were collected using semi-structured interviews with seniors and family caregivers who had participated in the project (n = 14). Descriptive qualitative analysis revealed the significance of the care manager’s role in offering social and emotional connection and non-stigmatizing support to seniors living at home and self-managing their physical and mental health.
Résumé
La présente étude rend compte des résultats d’une évaluation d’un projet pilote triennal de soins offerts en collaboration dans un contexte de soins de santé primaires au Canada destiné à évaluer et à traiter des personnes âgées (65 ans et plus) vivant à domicile et souffrant d’une maladie physique chronique et de troubles dépressifs ou anxieux concomitants. Les données ont été recueillies au moyen d’entrevues semi-structurées réalisées avec des personnes âgées et des aidants naturels ayant pris part au projet (n = 14). L’analyse qualitative descriptive a révélé l’importance du rôle du gestionnaire de soins dans l’établissement d’un lien social et émotionnel et l’apport d’un soutien non stigmatisant aux personnes âgées vivant à domicile et gérant eux-mêmes leur santé physique et mentale.
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References
Alexopoulos G. S. and Arean P. 2014 A model for streamlining psychotherapy in the RDoC era: The example of “engage.” Molecular Psychiatry 19 1 14 -19
Alexopoulos G. S., Raue P. J., Gunning F., Kiosses D. N., Kanellopoulos D., Pollari C., Banerjee S., and Arean P. A. 2016 “Engage” therapy: Behavioral activation and improvement of late-life major depression American Journal of Geriatric Psychiatry 24 4 320 -326
Bahm A. and Forchuk C. 2009 Interlocking oppressions: The effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada Health & Social Care in the Community 17 1 63 -70
Bayliss E. A., Ellis J. L., and Steiner J. F. 2007 Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities Annals of Family Medicine 5 5 395 -402
Berkkman L. F. 2000 Which influences cognitive function: Living alone or being alone? Lancet 355 1291 -192
Birrer R. B. and Vermuri S. P. 2004 Depression in later life: A diagnostic and therapeutic challenge American Family Physician 69 2375 -2382
Boyd C. M. and Fortin M. 2010 Future of multi-morbidity research: How should understanding multi-morbidity inform health system design? Public Health Reviews 32 451 -74
Bullock, H. L., Waddell, K., & Wilson, M. G. (2017). Rapid synthesis: Identifying and assessing core components of collaborative-care models for treating mental and physical health conditions. McMaster Health Forum.
Chan B. T. 2002 The declining comprehensiveness of primary care Canadian Medical Association Journal 166 4 429 -34
Clarke D. M. and Currie K. C. 2009 Depression, anxiety and their relationship with chronic diseases: A review of the epidemiology, risk and treatment evidence Medical Journal of Australia 190 7 Suppl S54 -S60
Conner K. O., McKinnon S. A., Roker R., Ward C. J., and Brown C. 2018 Mitigating the stigma of mental illness among older adults living with depression: The benefit of contact with a peer educator Stigma and Health 3 2 93 -101
Corrigan P. 2004 How stigma interferes with mental health care American Psychology 59 614 -625
Coventry P. A., Lovell K., Dickens C., Bower P., Chew-Graham C., Cherrington A., Garrett C., Gibbons C.J., Baguley C., Roughley K., Adeyemi I., Keyworth C., Waheed W., Hann M., Davies L., Jeeva F., Roberts C., Knowles S., and Gask L. 2012 Collaborative interventions for circulation and depression (COINCIDE): Study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease Trials 13 139
Craven M. A. and Bland R. 2013 Depression in primary care: Current and future challenges Canadian Journal of Psychiatry 58 8 442 -448
Dham P., Colman S., Spaerson K., McAiney C., Lourenco L., Kates N., and Rajii T. K. 2017 Collaborative care for psychiatric disorders in older adults: A systematic review Canadian Journal of Psychiatry 62 11 761 -771
Depla M. F. I. A., de Graaf R., van Weeghel J., and Heeren T. J. 2005 The role of stigma in the quality of life of older adults with severe mental illness International Journal of Geriatric Psychiatry 20 2 146 -153
Fortin M., Lapointe L., Hudon C., Vanasse A., Ntetu A. L., and Maltais D. 2004 Multi-morbidity and quality of life in primary care: A systematic review Health and Quality of Life Outcomes 2 51
Fortin M., Bravo G., Hudon C., Lapointe L., Almirall J., Dubois M. F., and Vanasse A. 2006a Relationship between multi-morbidity and health-related quality of life of patients in primary care Quality of Life Research 15 1 83 -91
Fortin M., Bravo G., Hudon C., Vanasse A., and Lapointe L. 2006b Prevalence of multi-morbidity among adults seen in family practice Annals of Family Medicine 3 3 223 -228
Fried T. R., Tinetti M. E., and Iannone L. 2011 Primary care clinicians’ experiences with treatment decision making for older persons with multiple conditions Archives of Internal Medicine 171 1 75 -80
Hawton A., Green C., Dickens A. P., Richards S. H., Taylor R. S., Edwards R., Greaves C.J., and Campbell J. L. 2011 The impact of social isolation on the health status and health-related quality of life of older people Quality of Life Research 20 1 57 -67
Holm A., Lyberg A., and Severinsson E. 2014 Living with stigma: Depressed elderly person’s experiences of physical health problems Nursing Research and Practice 2014 1 -8
Gibbons H. M. 2016 Compulsory youthfulness: Intersections of ableism and ageism in ‘successful aging’ discourses Review of Disability Studies 12 2–3 70 -88
Gil A., Kuluskki K., Jaakkimainen L., Naganathan G., Upshur R., and Wodchis W. 2014 “Where do we go from here?” Health system frustrations expressed by patients with multi-morbidity, their care-givers, and family physicians Healthcare Policy 9 4 73 -89
Grundberg A., Ebbeskob B., Abrandt Dahlgren M., and Religa D. 2012 How community-dwelling seniors with multi-morbidity conceive the concept of mental health and factors that may influence it: A phenomenographic study International Journal of Qualitative Studies on Health Well-being 7 1 -13
Grundberg A., Ebbeskog B., Gustafsson S. A., and Religa D. 2014 Mental health-promoting dialogues from the perspective of community-dwelling seniors with multi-morbidity Journal of Multidisciplinary Healthcare 7 189 -199
Grundberg A., Hansson A., Hilleras P., and Religa D. 2016 Home care assistants’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multi-morbidity Journal of Multidisciplinary Healthcare 9 83 -95
Gunn J., Diggens J., Hegarty K., and Blashki G. 2006 A systematic review of complex system interventions designed to increase recovery from depression in primary care BMC Health Services Research 6 88
Ho J. W., Kuluski K., and Im J. 2017 “It’s a fight to get anything you need”—Accessing care in the community from the perspectives of people with multimorbidity Health Expectations 29 6 1311 -1319
Jones S. M. W., Amtmann D., and Gell N. 2016 A psychometric examination of multi-morbidity and mental health in older adults Aging & Mental Health 20 3 309 -317
Kates N. 2017 Mental health and primary care: Contributing to mental health system transformation in Canada Canadian Journal of Community Mental Health 36 Special Issue 4 33 -67
Kates N., Arroll B., Currie E., Hanlon C., Gask L., Klasen H., Meadows G., Rukundo G., Sunderji N., Rudd T., and Williams M. 2018 Improving collaboration between primary care and mental health services The World Journal of Biological Psychiatry
Katon W., Von Korff M., Lin E., and Simon G. 2001 Rethinking practitioner roles in chronic illness: The specialist, primary care physician, and the practice nurse General Hospital Psychiatry 23 138 -144
Katon W. J., Li E. H., Von Korff M., Ciechanowski P., Ludman E. J., and Young B. 2010 Collaborative care for patients with depression and chronic illnesses New England Journal of Medicine 363 27 2611 -2620
Knowles S. E., Chew-Graham C., Coupe N., Adeyemi I., Keyworth C., Thampy H., and Coventry P. A. 2013 Better together? A naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems Implementation Science 20 8 110
Kuluski K., Peckham A., Ashlinder G., Gagnon D., Wong-Cornall C., McKillop A., Parsons J., and Sheridan N. 2019 What is important to older people with multimordibity and their caregivers? Identifying attributes of person centered care from the user perspective International Journal of Integrated Care 19 3 4
Morgan M. A., Coates M. J., Dunbar J. A., Reddy P., Schlicht K., and Fuller J. 2013 The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: A randomised trial BMJ Open 3 1
Mulvale G., Danner U., and Pasic D. 2008 Advancing community-based collaborative mental health care through interdisciplinary family health teams in Ontario Canadian Journal of Community Mental Health 27 2 55 -73
Nicholson N. R. 2012 A review of social isolation: An important but underassessed condition in older adults Journal of Primary Prevention 33 137 -152
Orrell M., Collines E., Shergill S., and Katona C. 1995 Management of depression in the elderly by general practitioners: I. Use of antidepressants Family Practice 12 5 -11
Overend K., Lewis H., Bailey D., Bosanquet K., Chew-Graham C., Ekers D., Gascoyne S., Hems D., Holmes J., Keding A., McMillan D., Meer S., Mitchell N., Nutbrown S., Parrott S., Richards D., Traviss G., Trépel D., Woodhouse R., and Gilbody S. 2014 CASPER plus (CollAborative care in screen-positive EldeRs with major depressive disorder): Study protocol for a randomised controlled trial Trials 15 451
Rush N., Angermeyer M. C., and Corrigan P. W. 2005 Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma European Psychiatry 20 529 -539
Pearlman R. A. and Uhlmann R. F. 1991 Quality of life in elderly, chronically ill outpatients Journal of Gerontology 46 2 M31 -38
Perrella A., McAiney C., and Ploeg J. 2018 Rewards and challenges in caring for older adults with multiple chronic conditions: Perspective of seniors’ mental health case managers Canadian Journal of Community Mental Health 37 1 65 -79
Rijken M., van Kerkhof M., Dekker J., and Schellevis F. G. 2005 Comorbidity of chronic diseases Quality of Life Research 14 1 45 -55
Salive M. E. 2013 Multi-morbidity in older adults Epidemiologic Reviews 35 1 7583
Sandelowski M. 2000 Focus on research methods: Whatever happened to qualitative description? Research in Nursing and Health 23 4 334 -340
Sirey J., Bruce M., Alexopoulos G., Perlick D., Raue P., Friedman S., and Meyers B. 2001 Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression American Journal of Psychiatry 158 479 -481
Smith-Carrier T., Pham T-N., Akhtar S., Seddon G., Nowaczynski M., and Sinha S. 2018 ‘It’s not just the word care, it’s the meaning of the word…(they) actually care’: Caregivers perceptions of home-based primary care in Toronto, Ontario Ageing and Society 38 10 2019 -2040
Sunderji, N., Ghavam-Rassoul, A., Ion, A., & Lin, E. . . (2016). Driving improvement in the implementation of collaborative mental health care: A quality framework to guide measurement, improvement and research. Retrieved from https://www.researchgate.net/publication/312539646_Driving_Improvements_in_the_Implementation_ of_Collaborative_Mental_Health_Care_A_Quality_Framework_to_Guide_Measurement_Improvement_and_ Research
Taylor A. K., Gilbody S., Bosanquet K., Overend K., Bailey D., Foster D., Lewis H., and Chew-Graham C. A. 2018 How should we implement collaborative care for older people with depression? A qualitative study using normalisation process theory within the CASPER plus trial BMC Family Practice 19 116
Thota A. B., Sipe T. A., Byard G. J., Zometa C. S., Hahn R. A., McKnight-Eily L. R., Chapman D. P., Abraido-Lanza A. F., Pearson J. L., Anderson C. W., Gelenberg A. J., Hennessy K. D., Duffy F. F., Vernon-Smiley M. E., Nease D. E., Williams S. P., and Community Preventative Servics Task Force 2012 Collaborative care to improve the management of depressive disorders: A community guide to systematic review and meta-analysis American Journal of Preventative Medicine 42 5 525 -538
Tinetti M. E., Fried T. R., and Boyd C. M. 2012 Designing health care for the most common chronic conditions— multi-morbidity JAMA 307 23 2493 -2494
Unützer J., Katon W., Callahan C. M., Williams J. W. Jr, Hunkeler E., Harpole L., Hoffing M., Della Penna R. D., Hitchcock Noël P., Lin E. H. B., Areán P. A., Hegel M. T., Tang L., Belin T. R., Oishi S., Langson C., Langston C., and IMPACT Investigators 2002 Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial JAMA 288 22 2836 -2845
Upshur R. and Tracy S. 2008 Chronicity and complexity. Is what’s good for the diseases always good for the patients? Canadian Family Physician 54 1655 -1658
Van den Akker M., Buntinx F., Metsemakers J. F. M., Roos S., and Knotnerus J. A. 1998 Multi-morbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases Journal of Clinical Epidemiology 51 5 367 -75
Van Kempen J., Zuidema S. U., Rikkert M., and Schers H. J. 2012 Home visits for frail older people: A qualitative study on the needs and preferences of frail older people and their informal caregivers British Journal of General Practice 62 601 e554 -e560
Von Kolff M., Katon W., Lin E., Ciechanowski P., Peterson D., Ludman E., Young B., and Rutter C. 2011 Functional outcomes of multi-condition collaborative care and successful ageing: Results of randomized trial BMJ 343 d6612
Wajnberg A., Wang K. H., Aniff M., and Kunins H. V. 2010 Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program Journal of the American Geriatrics Society 58 6 1144 -1147
Webster F., Christian J., Mansfield E., Bhattacharyya O., Hawker G., Levinson W., Nagile G., Pham T., Rose L., Schull M., Sinha S., Sterigopoulos V., Upshur R., and Wilson L. 2015 Capturing the experiences of patients across multiple complex interventions: A meta-qualitative approach BMJ Open 5 9 e007664
Wikman A., Wardle J., and Steptoe A. 2011 Quality of life and affective well-being in middle-aged and older people with chronic medical illnesses: A cross-sectional population-based study PLoS One 6 4 e18952
Wood E., Ohlsen S., and Ricketts T. 2017 What are the barriers and facilitators to implementing collaborative care for depression? A systematic review Journal of Affective Disorders 214 26 -43
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Canadian Journal of Community Mental Health
Volume 40 • Number 1 • May 2021
Pages: 53 - 66
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Version of record online: 5 April 2021
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Sara Martel, Penny Dowedoff, Michelle Marcinow, Reenu Arora, Jason Kerr, Richard Shulman, and Elizabeth Mansfield. 2021. Patient and Family Caregiver Experience with a Collaborative Care Pilot Project to Support Seniors Managing Multi-Morbidity in a Primary Care Setting. Canadian Journal of Community Mental Health.
40(1): 53-66. https://doi.org/10.7870/cjcmh-2021-003
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