A Telephone-Based Program to Provide Symptom Monitoring Alone vs Symptom Monitoring Plus Care Management for Late-Life XXXX : A Randomized Clinical Trial.

@entity1 @entity1032 @entity308 @entity148 @entity258
Importance: @entity1032 ( @entity1032 ) conditions are undertreated in late life. It is important to identify treatment strategies that address variability in treatment content and delivery and take individual-specific symptoms into account, particularly among @entity258 , community-dwelling older adults. Objective: To evaluate program feasibility and @entity1032 outcomes among community-dwelling older adults randomized to 1 of 2 treatment arms of varying intensity of evidence-based, collaborative @entity1032 care management services (ie, the Supporting Seniors Receiving Treatment and Intervention [SUSTAIN] program) that provide standardized, measurement-based, software-aided @entity1032 assessment and symptom monitoring and connection to community resources via telephone. Design, Setting, and @entity1 : Trial @entity1 were 1018 older, community-dwelling, @entity258 adults prescribed an antidepressant or anxiolytic by a primary care or non- @entity1032 professional and experiencing clinically significant @entity1032 symptoms at intake. The @entity1 subsample was drawn from a larger parent sample of older adults enrolled in the SUSTAIN program. Individuals were randomized to receive @entity1032 symptom monitoring alone (hereafter monitoring alone) or @entity1032 symptom monitoring plus care management (hereafter care management) provided by an @entity1032 professional. Baseline characteristics were examined, and changes in clinical @entity1032 outcomes were evaluated at 3-month and 6-month follow-up. The study dates were August 5, 2010, to May 5, 2014. Interventions: Monitoring alone or care management delivered by an @entity1032 professional. Main Outcomes and Measures: Overall @entity1032 functioning (primary) and @entity308 . Results: A total of 509 @entity1 were randomized to the monitoring alone group and 509 to the care management group; 377 and 401 completed >= 2 research assessments in the monitoring alone and case management groups, respectively. Compared with those randomized to monitoring alone, individuals randomized to care management showed greater improvements in the 3 domains of @entity1032 functioning (b [SE], 0.36 [0.12]; 95% CI, 0.12 to 0.60; P   =   .004), @entity308 (b [SE], -0.20 [0.06]; 95% CI, -0.32 to -0.09; P   <   .001), and @entity148 (b [SE], -0.23 [0.05]; 95% CI, -0.33 to -0.14; P   <   .001) over time. Conclusions and Relevance: The SUSTAIN program, which provides assessment, monitoring, care management, and brief therapies for @entity1032 symptoms and needs in primary care settings, is feasible and scalable. A more intense level of care (ie, symptom monitoring plus care management) is associated with more favorable individual outcomes for @entity258 , community-dwelling older adults experiencing clinically significant @entity1032 symptoms. Trial Registration: clinicaltrials.gov Identifier: NCT02440594.
