Physician implementation of and patient adherence to recommendations from comprehensive geriatric assessment.
OBJECTIVE
The goals of this study were to develop and determine the feasibility of interventions designed to increase both primary care physician implementation of and patient adherence to recommendations from ambulatory-based consultative comprehensive geriatric assessment (CGA), and to identify sociodemographic and intervention-related predictors of physician and patient adherence.


METHODS
One hundred thirty-nine community-dwelling older persons who failed a screen for functional impairment, depressive symptoms, falls, or urinary incontinence received outpatient CGA consultation. 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. Recommendations were classified as physician-initiated or self-care and as "major" or "minor"; one was deemed "most important". Adherence rates were determined on the basis of face-to-face interviews with patients.


RESULTS
Based on 528 recommendations for 139 subjects, physician implementation of "most important" recommendations was 83% and of major recommendations was 78.5%. Patient adherence with physician-initiated "most important" and "major" recommendations were 81.8% and 78.8% respectively. In multivariate models, only the status of the recommendation of "most important" (odds ratio 2.4, 95% CI [confidence interval] 1.3 to 4.5) and health maintenance organization (HMO) status of the patient (odds ratio 2.1, 95% CI 1.3 to 3.6) remained significant in predicting physician implementation. The logistic model predicting patient adherence to physician-initiated recommendations included male patient gender (odds ratio 3.1, 95% CI 1.3 to 7.0), the status of the recommendation of "most important" (odds ratio 1.9, 95% CI 1.0 to 3.8), total number of recommendations (odds ratio 0.7, 95% CI 0.5 to 0.9), and total number of problems identified by CGA (odds ratio 1.8, 95% CI 1.2 to 2.7).


CONCLUSIONS
These findings indicate that relatively modest interventions 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".
Reuben
D B
DB
Multicampus Program in Geriatric Medicine and Gerontology, UCLA School of Medicine, Los Angeles, California 90095-1687, USA.
Maly
R C
RC
Hirsch
S H
SH
Frank
J C
JC
Oakes
A M
AM
Siu
A L
AL
Hays
R D
RD
D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000553:Ambulatory Care; D003863:Depression / Q000175:diagnosis; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D005544:Forecasting; D015577:Geriatric Assessment; D006279:Health Maintenance Organizations; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation; D012648:Self Care; D012737:Sex Factors; D014549:Urinary Incontinence / Q000175:diagnosis