Objective: Although many elderly patients in primary care practices suffer from cognitive impairment (27%), depression (23%), sleep problems (44%), and alcohol abuse (4%), documentation and followup of these problems occur uncommonly. This results in increased human suffering for patients and caregivers, additional health care costs, and excess disability. One of the objectives of the Partners in Care program was to increase knowledge and awareness of such conditions.
Design: Partners in Care establishes a screening in the primary care waiting room, followed by care management with specific emphasis on follow up of behavioral health illnesses and symptoms. Approximately 2,150 adult patients aged 65 years or older, from 11 sites in Chicago and downstate Illinois, were recruited from the waiting rooms of primary care practices and received a series of 45-minute screening interviews.
Materials and Methods: The patient interviews consisted of the following: Geriatric Depression Scale (GDS), Mini Mental Status Evaluation (MMSE), Seven-Minute Screen (7MS), Medical Outcomes Short Form, Lawton Activities of Daily Living, Hassles Scale, and others.
In the seven treatment sites, patients who screen positive for depression, sleep, medication management, frequent falls, and cognitive problems are signaled for social worker interventions. At the four control sites, there are no social workers. At all 11 sites, primary care physicians are notified when a participant screens positively as a signal case.
Chart reviews covering a six-month to one-year period prior to each interview were conducted to determine the extent to which any signs or symptoms associated with cognitive impairment were noted.
Results: In our initial sample, 22% screened positive for depression on the Geriatric Depression Scale, and 27% scored positively for cognitive impairment on either 7Minute Screen or the Mini Mental State Evaluation (MMSE). 15.9% of the sample had at least one fall in the previous six months. 70.4% responded affirmatively to one or more of three questions raised on sleep problems, and approximately 5% indicated some problem with alcohol abuse/misuse. The practices varied widely in patterns of prescribing psychotropic medications. Although benzodiazepine use was approximately 3% in most practices, in one practice it exceeded 20%.
Conclusion: We will present the results of 12-month follow up on the part of 7 of our 11 sites, which are due to conclude in April 2003. We will evaluate the impact of social work intervention on awareness and followup treatment for those designated signal cases.
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