title: Disclosure of new health problems and intervention planning using a geriatric assessment in a primary care setting.
abstract: OBJECTIVE
  To determine the prevalence of health problems uncovered by a Standardized Assessment for Elderly Patients in a Primary Care Setting (STEP), to explore how often STEP uncovered conditions new to general practitioners (GP) and ascertain how often STEP results led GPs to plan further interventions.
  
  
  METHODS
  This descriptive, interim analysis was based on the data of 189 elderly patients (median age, 78 years; interquartile range [IQ], 74-81) and their 20 GPs collected in Hannover region, Germany, between June 2008 and April 2009. Study nurses in the practice setting applied the 44-item STEP instrument, based mainly on self-reporting, as well as a standardized patient interview. Subsequently, GPs indicated whether the problems were new to them, and whether they planned further action or health interventions on the basis of the problems identified by STEP.
  
  
  RESULTS
  A median of 11 health problems (IQ, 8-14) were uncovered per patient, of which a median of 2 (IQ, 1-4) were new to the GP and interventions were planned for a median of 2 problems (IQ, 0-4). Many of the identified health problems are typical of old age. The following health problems uncovered by STEP were often new to the GPs (percentages differ to numbers due to missing GP ratings): cognitive impairment (33 of 64 affected by this problem, 73%), missing or unknown immunization status (84 of 160, 55%), and recent chest pain (19 of 37, 53%). Alcohol misuse was new in all 4 affected patients (100%) and recent falls were new in 5 of 7 patients (83%). Interventions for affected patients were frequently planned for problems of immunization (for 83 patients of 160 reporting the problem, 57%), current anxiety (4 of 9, 50%), and chest pain (14 of 37, 44%). Moreover, further management was frequently planned for depression (10 of 29, 39%) and cognitive impairment (16 of 64, 38%).
  
  
  CONCLUSIONS
  Using a geriatric assessment in primary care discloses relevant heath problems and treatment needs that GPs may otherwise overlook.
authors.affiliation: Christiane Muller, Institute of General Practice, Hannover Medical School, Carl-Neuberg Str.1, 30625 Hannover, Germany. Mueller.Christiane@mh-hannover.de
authors.forename: Christiane Annette
authors.initials: CA
authors.lastname: Muller
authors.forename: Renate
authors.initials: R
authors.lastname: Klaassen-Mielke
authors.forename: Erika
authors.initials: E
authors.lastname: Penner
authors.forename: Ulrike
authors.initials: U
authors.lastname: Junius-Walker
authors.forename: Eva
authors.initials: E
authors.lastname: Hummers-Pradier
authors.forename: Gudrun
authors.initials: G
authors.lastname: Theile
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis; D002908:Chronic Disease; D016001:Confidence Intervals; D003479:Curriculum; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods*; D006301:Health Services Needs and Demand; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D011320:Primary Health Care / Q000379:methods*; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires