Initial Results From an Integrated Mental Health Collaborative Care Model in a National Teleneurology Clinic.
Eric Anderson1, Danielle Geraldi-Samara1, Elizabeth Ferluga1, Noreen Flanagan1, Kevin Brendle1
1Synapticure
Objective:
Integration of a Mental Health Collaborative Care Model (COCM) into a national  teleneurology clinic improves access to psychiatric resources and reduces neuropsychiatric burden for those living with Amyotrophic Lateral Sclerosis (ALS) and Parkinson's Disease (PD)
Background:

People living with ALS and PD are both affected by neuropsychiatric symptoms which impact quality of life and exacerbate overall disease burden.  Depression and anxiety are predominant neuropsychiatric complaints with a higher risk of suicide compared to the general population. Mental health care access is limited by geographic and mobility challenges and a paucity of resources.  

COCM leverages behavioral health care managers, remote psychiatry, and a registry tracking symptoms.  Despite increasing use in primary care, no reports of COCM in a teleneurology clinic exist.  COCM contrasts with the conventional referral approach, which often results in failure to establish care, fragmented care, and delayed interventions.


Design/Methods:

COCM was integrated into our teleneurology clinic by incorporating behavioral health care managers, psychologists, psychiatrists, and new workflows to facilitate non-siloed collaboration. A registry was created to track standardized measurements of depression and anxiety (PHQ-9 and GAD-7).  73 ALS, and 47 PD patients were enrolled from 26 different states, and measures of symptom improvement were analyzed. 


Results:

There was a significant reduction in both the PHQ-9 (7.92 to 6.58 ALS; 10.88 to 7.29 PD) and GAD-7 (6.66 to 4.79 ALS; 9.49 to 6.64 PD) within the first 4 months. 90% made use of psychological therapy, including individual therapy (86% ALS; 77% PD), family therapy (26% ALS; 19% PD), and group therapy (34% ALS; 45% PD).  Most are managed on psychotropic medications (77% ALS;  83% PD).


Conclusions:

Integration of COCM into a national teleneurology clinic improved access for people with ALS and PD. Within four months, there was a reduction in the neuropsychiatric burden through the use of focused therapy, counseling, and psychotropic medications. 


10.1212/WNL.0000000000211793
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