Interdisciplinary geriatric primary care evaluation and management: two-year outcomes.
BACKGROUND
The long-term efficacy of interdisciplinary outpatient primary care Geriatric Evaluation and Management (GEM) has not been proven. This article focuses on results obtained during the 2 years of the study.


METHODS
In this 2-year randomized clinical trial, at the Veterans Affairs Medical Center, Memphis, TN, 128 veterans, age 65 years and older, were randomized to outpatient GEM or usual care (UC). Two-year follow-up analyses are based on the 98 surviving individuals. Study outcome measurements included health status, function, and quality of life including affect, cognition, and mortality.


RESULTS
At 2 years, there were positive intervention effects for eight of 1 outcome measures, five of which had attained significance at 1 year. GEM subjects, compared with UC subjects, had significantly greater improvement in health perception (P = .001), smaller increases in numbers of clinic visits (P = .019) and instrumental activities of daily living (IADL) impairments (P = .006), improved social activity (P<.001), greater improvement in Center for Epidemiologic Studies-Depression (CES-D) scores (P = .003), general well-being (P = .001), life satisfaction (P<.001), and Mini-Mental State Exam (MMSE) scores (P = .025). There were no significant treatment effects in activities of daily living (ADL) scores (P = .386), number of hospitalizations (P = .377), or mortality (P = .155).


CONCLUSIONS
These findings suggest that a primary care approach that combines an initial interdisciplinary comprehensive assessment with long-term, interdisciplinary outpatient management may improve outcomes for targeted older adults significantly. Findings suggest further that outcomes may continue to improve over time and that the GEM care model provides an effective way to manage health care of older adults.
Burns
R
R
Department of Preventive Medicine, University of Tennessee, Memphis, USA.
Nichols
L O
LO
Martindale-Adams
J
J
Graney
M J
MJ
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005853:Geriatrics / Q000458:organization & administration*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008603:Mental Health; D009026:Mortality; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D013714:Tennessee; D014481:United States; D014493:United States Department of Veterans Affairs