Abstract
BackgroundIn 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.MethodsData 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.ResultsTwo 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.ConclusionsThe 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.
Highlights
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 [1]
Patient characteristics A total of 396 patients with concurrent Major Depressive Disorder treatment as usual (TAU) Treatment as usual (MDD) and Alcohol Use Disorder (AUD) were enrolled into ICP across the 9 sites including 44 patients who started their treatment before the DA VINCI project was funded and the 81 patients included into previous report [24]
Individual format of therapy and academic settings were associated with significantly better improvement in specific aspects of drinking patterns. These findings corroborate our preliminary reports on ICP – at the pilot stage, with a small sample or patients (n = 28) we reported 80% retention rate at 12 weeks, which is in line with our current definition of ICP completion, and a tendency of reduction in depressive symptoms and alcohol consumption [8]
Summary
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 [1]. These two conditions were chosen as both of them are highly prevalent in Canada and worldwide [2, 3] and often are comorbid with each other, which significantly complicates their effective treatment [4]. The 22-month project was named DA VINCI (Depression and Alcoholism: Validation of an Integrated Care Initiative) and was completed in January 2017 with the ICP fully implemented at nine clinical sites including CAMH
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