Delivering effective primary care to older adults: a randomized, controlled trial of the senior resource team at group health cooperative.
OBJECTIVE
To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older.


METHODS
Randomized, controlled trial.


METHODS
Two primary care clinics in the Seattle, Washington, area.


METHODS
Thirty-one PCPs and 874 patients aged 75 and older.


METHODS
An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care.


METHODS
Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2-Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed.


RESULTS
Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high-risk prescribing at 12 or 24 months of follow-up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy-eight participants died over the 24 months of follow-up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P=.03).


CONCLUSIONS
The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality.
Phelan
Elizabeth A
EA
Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA. phelane@u.washington.edu
Balderson
Benjamin
B
Levine
Martin
M
Erro
Janet H
JH
Jordan
Luesa
L
Grothaus
Lou
L
Sandhu
Nirmala
N
Perrault
Patrick J
PJ
Logerfo
James P
JP
Wagner
Edward H
EH
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000458:organization & administration*; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006299:Health Services for the Aged / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D016019:Survival Analysis; D014861:Washington
D000959:Antihypertensive Agents