Improving home-based providers' communication to primary care providers to enhance care coordination.
OBJECTIVE
Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol ('BRIDGE - BRinging Inter-Disciplinary Guidelines to Elders') in conjunction with DCM.


METHODS
In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants' primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months.


RESULTS
Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants' depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73-2.3). Participants were satisfied.


CONCLUSIONS
Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.
a Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute , University of South Florida , Tampa , FL , USA.
Amber M
AM
Gum
Natalie D
ND
Dautovich
Jennifer
J
Greene
Anne
A
Hirsch
Lawrence
L
Schonfeld
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003863:Depression / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management; D011320:Primary Health Care; D015397:Program Evaluation; D011785:Quality Assurance, Health Care
collaboration; depression; home care; social services