Physician Implementation of and Patient Adherence to Recommendations from Comprehensive Geriatric Assessment

Published In: The American Journal of Medicine, v. 100, no. 4, Apr. 1996, p. 444-451

Posted on RAND.org on January 01, 1996

by David Reuben, Rose C. Maly, Susan H. Hirsch, Janet C. Frank, Allison Mayer-Oakes, Albert L. Siu, Ron D. Hays

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Tests the feasibility of interventions designed to increase primary care physician implementation of and patient adherence to recommendations from ambulatory-based consultative comprehensive geriatric assessment (CGA), and to identify predictors of physician and patient adherence. Receiving outpatient CGA consultation were 139 community-dwelling older persons who failed a screen for functional impairment, depressive symptoms, falls, or urinary incontinence. These patients and the 115 physicians who provided primary care for them received one of three adherence interventions, each of which had a physician education component and a patient education and empowerment component classified as physician-initiated or self-care and as major or minor; one was deemed most important. Adherence rates were determined based on 528 recommendations for 139 subjects; physician implementation and patient adherence to major recommendations were about 80%. In multivariate models, only the status of the recommendation, most important, and health maintenance organization (HMO) status of the patient remained significant. Relatively modest intervention strategies are feasible and lead to high levels of physician implementation of and patient adherence to physician-initiated CGA recommendations. These interventions appear to be particularly effective in HMO patients and for recommendations that were deemed to be most important.

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