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BMC Psychiatry. 2018 Jun 13;18(1):189. doi: 10.1186/s12888-018-1770-3.

Outcomes of an integrated care pathway for concurrent major depressive and alcohol use disorders: a multisite prospective cohort study.

Samokhvalov AV1,2,3,4, Probst C5,6,7, Awan S8, George TP8,9,10, Le Foll B8,9,5,10,11, Voore P8,10, Rehm J8,9,5,10,11,12,13,6,7.

Author information

1
Addictions Division, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Office T519, Toronto, ON, M5S 2S1, Canada. andriy.samokhvalov@camh.ca.
2
Institute for Medical Science, University of Toronto, Toronto, ON, Canada. andriy.samokhvalov@camh.ca.
3
Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada. andriy.samokhvalov@camh.ca.
4
Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada. andriy.samokhvalov@camh.ca.
5
Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada.
6
Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Sachsen, Germany.
7
WHO Collaborating Centre on Mental Health and Addiction, Toronto, ON, Canada.
8
Addictions Division, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Office T519, Toronto, ON, M5S 2S1, Canada.
9
Institute for Medical Science, University of Toronto, Toronto, ON, Canada.
10
Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
11
Campbell Family Mental Health Research Institute, Toronto, ON, Canada.
12
Division of Adult Psychiatry and Health Systems, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
13
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

In 2013, an Integrated Care Pathway (ICP) for concurrent Major Depressive (MDD) and Alcohol Use (AUD) Disorders was developed at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada. The ICP was further implemented at 8 other clinical sites across Ontario (the DA VINCI Project) in 2015-2017. The goal of this study was to systematically describe and analyze the main clinical outcomes of the project.

METHODS:

Data on a non-randomized cohort of patients receiving ICP-based treatment were collected prospectively at nine clinical sites in a variety of clinical settings.

STATISTICAL METHODS:

descriptive statistics, t-test, chi-square, ANOVA, generalized linear models.

RESULTS:

Two hundred forty-six patients were enrolled, 58.8% males, mean age was 45.6 years, 170 patients received treatment at academic health centres (AHC), 49 - at community hospitals (CH) and 27 - in family health teams (FHT). There were no major differences in anamnestic parameters and depression severity between the three settings, but there were differences in baseline drinking patterns between subgroups (F = 4.271, df = 2, p = 0.015). Overall completion rate was 70.7% with no significant variation between settings (χ2 = 3.35, df = 2, p = 0.19). Treatment duration in AHC was the longest, and completion rates were the highest. There was a statistically significant and clinically meaningful reduction in the number of drinking days per week (1.81, t = 8.78, p < 0.001). The cohort overall demonstrated significant and meaningful reduction in severity of cravings (Penn Alcohol Craving Scale: 4.42, t = 8.63, p < 0.001) and depressive symptoms (Quick Inventory of Depressive Symptomatology: 4.25, t = 11.26, p < 0.001). While some of the baseline patient characteristics and treatment parameters varied between the settings, the variation in clinical outcomes was mostly insignificant, though clinical improvement was more pronounced in academic setting and with individual therapy.

CONCLUSIONS:

The study demonstrated that ICP is a feasible and effective treatment for concurrent AUD and MDD that delivers meaningful clinical improvement in a variety of settings. A randomized controlled study is needed to properly compare the treatment outcomes between ICP model and treatment as usual and to further explore the role of various factors on treatment outcomes.

KEYWORDS:

Alcohol use disorder; Care pathway; Concurrent disorders; Integrated treatment; Major depressive disorder; Pharmacotherapy; Psychotherapy

PMID:
29898697
PMCID:
PMC6001012
DOI:
10.1186/s12888-018-1770-3
[Indexed for MEDLINE]
Free PMC Article

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