We have completed a pilot study of the Medical-Psychiatric Coordinating Physician (MPCP) model, consisting of 52 outpatient cases treated by two physicians and a clinical psychologist, including Steven A. Frankel, MD and Philip Erdberg, PhD. Each treatment lasted for at least 18 months. Subjects with systemic medical and psychiatric co-morbidity were selected from a pool of office-based patients according to the following criteria:
- At least two other professionals, including physicians and psychotherapists, had been involved in their care.
- At least two other treatments lasting 18 months or longer had been attempted previously and failed.
- The patient required extra support in addition to scheduled office visits, such as phone calls, emails, or additional urgent appointments.
Frankel and Erdberg have used iterations of this treatment approach for over twenty years. These treatments were part of two earlier projects studying collaborative clinical approaches and were precursors of the currently formulated MPCP-led team treatment model. The Hamilton Rating Scale for Depression and the HRQOL-14 Health-Related Quality of Life measure were administered at the beginning of each treatment and then repeatedly at three-month intervals. Comprehensive clinical review indicated distinct improvement in at least two clinical dimensions for 44 of the 52 studied patients, following adoption of the MPCP model.
Outcome criteria included:
- Reduced utilization of medical resources, as reflected by (a) 1/3 fewer calls and visits to the case-associated PCP and/or MPCP, assessed by comparing successive six month periods; (b) little or no consistent increase in the requirement for nonessential specialists over the course of treatment, and (c) half as many emergency department visits and hospitalizations compared to the previous two years.
- Improved treatment adherence, by physician report.
- Clinically relevant reduction in symptom severity (using standardized rating scales, e.g., the Hamilton Rating Scale for Depression)
- Improved quality of life (by rating scales specifying: physical, emotional, and social functioning; role performance; and pain or other symptoms such as fatigue or nausea).
We find the MPCP method of care delivery to be quite promising as an antidote to the typical unwieldy and fragmented approaches to the most problematic group of complex patients. We are in the process of initiating additional, formal, studies as a follow-up to our pilot project. In each new study, patients selected according to type and degree of complexity will be recruited and randomly assigned for MPCP treatment versus treatment as usual using at least one other modality. Outcome criteria will include such parameters as symptom resolution, treatment adherence, improved patient functioning, quality of life, containment of treatment costs, and the utilization of medical resources including physician time. We are vigorously pursuing this further research to validate and expand on the findings from our pilot study.