Changes in the delivery of health care services for the elderly have it pertinent to establish a closer link between patient oriented research, the delivery of health care services and the development of health care delivery systems. Unfortunately, in the case of behavioral science, training in the development and delivery of clinical interventions for the elderly is not sufficient for competency in the development and evaluation of large primary health care delivery systems. The result is a wealth of behavioral science interventions that are never transitioned into primary health care delivery systems, and health care delivery systems that are often unable to adequately address the behavioral needs for elderly patients. This discontinuity between behavioral and medical care is highlighted in the mis- diagnosis and mismanagement of distress among the elderly in primary care. Psychological distress, in the absence of a psychiatric disorder is extremely prevalent among the elderly in primary care and accounts for a significant percentage of office visits, increased medical costs, and diminished health status and well being. Despite the prevalence and burden on the health care system, behavioral interventions are not a routine part of clinical care. A promising laboratory based written self-disclosure protocol has extensive evidence of reducing health care utilization, improving perceptions of health status and psychological well being in non health care seeking adults. The protocol has not, however, been integrated and evaluated in the geriatric primary care setting. The proposed study aims to evaluate the effectiveness of a self-disclose intervention in a randomized controlled trial in 195 elderly primary care patients enrolled in a managed care program. Primary outcome measures including service utilization and associated costs, health related quality of life, and distress, will be evaluated at baseline, 1 and 6 months post intervention. The proposed study is part of a 5-year career development plan consisting of course work and supervised research fieldwork focusing on the development and evaluation of health care delivery systems for the elderly. The proposed plan will provide the necessary training experiences to: 1. Function as an independent researcher developing and evaluating behavior science interventions to improve health status and reduce resource utilization in older primary care patients. 2. Obtain training experiences that will facilitate the integration of research findings into the development and evaluation of geriatric primary care delivery systems.
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