Although previous studies have demonstrated health benefits of comprehensive geriatric assessment (CGA) in inpatient and rehabilitation settings, its value in other settings in uncertain. Primary care physician non-compliance with CGA recommendations has been considered an important factor in the failure to assessment must also consider patient compliance and access to needed services. The purpose of this intervention development study (IDS) is to improve the effectiveness of geriatric assessment by developing and testing strategies to increase both primary care physician and patient compliance with recommendations of the CGA team. The proposed study is divided into three phases: determinants of compliance; development, testing, and refinement of the intervention; and application of the intervention in a randomized clinical trial that tests the effectiveness of ambulatory-based CGA. To achieve these aims, we will recruit a study sample from the Project Safety Net, a community-based outreach program. Subjects will be screened using a instrument comprised of four subscales of the Functional Status Questionnaire and specific questions about urinary incontinence and falls during the previous month. Subjects failing the screen will undergo a standardized CGA by a social worker, a gerontologic nurse practitioner, a physical therapist (when appropriate), and a geriatrician (when indicated). In this first phase of the study, patients and their primary care physicians will be contacted to determine general and specific reasons for non-compliance. During the second phase, the study team will develop low and high intensity interventions to increase physician and patient compliance. Physicians will then be randomized into groups that will receive information about CGA recommendations by each strategy. The principal outcomes of this phase are implementation of recommendations for four target conditions at the physician level and adherence with recommendations at the patient level. If successful, this IDS is anticipated to lead to an intervention study to begin in year three of the OAIC funding period. Criteria for success include demonstration of adequate patient and physician willingness to participate, the potential for recruiting adequate numbers of subjects, and the development of an intervention directed at primary care physicians that will lead to implementation of 80% of appropriate recommendations for the four conditions.
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