Evaluation of the Achieving Depression and Anxiety Patient Centered Treatment (ADAPT) Program (ADAPT)

Evaluating the Implementation and Outcomes of the Achieving Depression and Anxiety Patient Centered Treatment (ADAPT) Collaborative Care Program in A Large, Integrated Healthcare System: A Mixed Methods Observational Study Protocol

Depression and anxiety are increasingly common conditions for which primary care providers (PCPs) serve as the initial healthcare contact for most patients. Comorbid depression and anxiety result in higher costs, and treatment as usual, which is referrals to specialty psychiatric care, often contribute to delays in care. Collaborative psychiatric care is an evidence-based strategy to increase mental healthcare access while reducing costs. ADAPT is a novel collaborative care model. By using technology-driven appointments with providers, ADAPT increases access to mental healthcare, and reduces member wait times. This mixed methods study will assess implementation measures of the ADAPT program and the components of ADAPT related to patient mental health improvement compared to specialty mental health care. The hypothesis is that: ADAPT program will have good program reach and efficacy. We will examine program implementation and maintenance. Further, the study looks to uncover member and program characteristics that are associated with depression and anxiety remission and care utilization.

Study Overview

• Status: Withdrawn
• Conditions: Depression; Anxiety
• Intervention / Treatment: Behavioral: ADAPT

• Study Type: Observational

Contacts and Locations

Study Locations

• United States
  • California
    • Oakland, California, United States, 94612
      • Kaiser Permanente Northern California Division of Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Kaiser Permanente Northern California adult members who screen positive for depression or anxiety in primary care and are referred to treatment.

Description

Inclusion Criteria:

• Adult Outcomes Questionnaire (AOQ) score between 10-30
• English-Speaking

Exclusion Criteria:

• High risk for suicide defined by answer to question 9 on PHQ-9 of 1 or more
• Diagnosis of bipolar disorder
• Diagnosis of a psychotic disorder
• Dementia diagnosis
• Active substance use disorder diagnosis
• Current hospice
• Current home-based palliative care
• Residing in a skilled nursing facility
• Residing in an assisted living facility
• Non-Kaiser Permanente Member
• Established psychiatric care outside of Kaiser Permanente

Study Plan

How is the study designed?

Design Details

• Observational Models: Ecologic or Community
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control; Patients receiving referral to specialty mental healthcare
ADAPT	Behavioral: ADAPT; The Achieving Depression and Anxiety Patient Centered Treatment (ADAPT) Program is a novel collaborative psychiatric care model that is designed to unburden PCPs and psychiatrists, increase access to quality specialty mental healthcare for Kaiser Permanente members, and improve patient depression and anxiety treatment outcomes by utilizing technology-driven appointments. This program uses principles of collaborative care, including patient-centered care, population-based care, evidence-based care, measurement-based treatment to target, and accountable care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient reach	Examine and compare patients eligible and enrolled in ADAPT versus those eligible but not enrolled in ADAPT	through study completion, 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Member characteristics associated with depression remission	Clinical variables important to predicting intervention response: Patient demographics (age, sex, race/ethnicity, socioeconomic status), behavioral characteristics (exercise, sleep), and other individual characteristics (comorbidities, adverse childhood experiences, social supports, resilience).	baseline, 3 and 6 months
Member characteristics associated with anxiety remission	Clinical variables important to predicting intervention response: Patient demographics (age, sex, race/ethnicity, socioeconomic status), behavioral characteristics (exercise, sleep), and other individual characteristics (comorbidities, adverse childhood experiences, social supports, resilience).	baseline, 3 and 6 months
Efficacy: Patient therapy engagement	number of therapy contacts (individual, group and combined)	baseline, 3 and 6 months
Efficacy: Patient medication provider engagement	number of clinical pharmacy contacts	baseline, 3 and 6 months
Efficacy: Patient medication engagement	medication length of treatment	baseline, 3 and 6 months
Efficacy: Patient psychiatry engagement	number of contact with psychiatrist	baseline, 3 and 6 months
Efficacy: Patient time to care	average time from ADAPT referral to first appointment with therapist or pharmacist	baseline, 3 and 6 months
Efficacy: Depression outcomes	Examine if patients enrolled in ADAPT demonstrate non-inferior depression outcomes defined by change in the patient health questionnaire (PHQ-9) score compared to treatment as usual.	baseline, 3 and 6 months
Efficacy: Anxiety outcomes	Examine if patients enrolled in ADAPT demonstrate non-inferior anxiety outcomes defined by generalized anxiety disorder (GAD-2) score compared to treatment as usual.	baseline, 3 and 6 months
Efficacy: Time to clinical improvement	Compare time to clinical improvement as defined by change in Adult Outcomes Questionnaire (AOQ score) from baseline to 3, and 6 months for members in ADAPT compared to treatment as usual.	baseline, 3 and 6 months
Implementation: measurement-based care	Examine provider use of measurement-based care	through study completion, 2 years
Implementation: Diagnosis	Examine provider use of a specific depression or anxiety diagnosis	through study completion, 2 years
Maintenance: Measurement-based care	Examine provider use of measurement-based care over time	through study completion, 2 years
Maintenance: Diagnosis	Examine provider use of a specific depression or anxiety diagnosis over time	through study completion, 2 years

Collaborators and Investigators

• Sponsor: Kaiser Permanente
• Investigators: Principal Investigator: Kathryn K Erickson-Ridout, MD PhD, Kaiser Permanente

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): December 31, 2022

Study Registration Dates

• First Submitted: March 29, 2021
• First Submitted That Met QC Criteria: April 7, 2021
• First Posted (Actual): April 9, 2021

Study Record Updates

• Last Update Posted (Actual): March 2, 2023
• Last Update Submitted That Met QC Criteria: February 28, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: Depression; Anxiety
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder; Anxiety Disorders
• Other Study ID Numbers: 1421043

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No