PHYSICIAN IMPLEMENTATION OF AND PATIENT ADHERENCE TO RECOMMENDATIONS FROM COMPREHENSIVE GERIATRIC ASSESSMENT

PURPOSE: The goals of this study were to develop and determine the fea sibility of interventions designed to increase both primary care physi cian implementation of and patient adherence to recommendations from a mbulatory-based consultative comprehensive geriatric assessment (CGA), and to identify sociodemographic and intervention-related predictors of physician and patient adherence. PATIENTS AND METHODS: One hundred thirty-nine community-dwelling older persons who failed a screen for f unctional impairment, depressive symptoms, falls, or urinary incontine nce received outpatient CGA consultation. These patients and the 115 p hysicians who provided primary care for them received one of three adh erence interventions, each of which had a physician education componen t and a patient education and empowerment component. Recommendations w ere classified as physician-initiated or self-care and as ''major'' or ''minor''; one was deemed ''most important.'' Adherence rates were de termined on the basis of face-to-face interviews with patients. RESULT S: Based on 528 recommendations for 139 subjects, physician implementa tion of ''most important.'' recommendations was 83% and of major recom mendations was 78.5%. Patient adherence with physician-initiated ''mos t important'' and ''major'' recommendations were 81.8% and 78.8%, resp ectively. In multivariate models, only the status of the recommendatio n of ''most important'' (odds ratio 2.4, 95% CI [confidence interval] 1.3 to 4.5) and health-maintenance organization (HMO) status of the pa tient (odds ratio 2.1, 95% CI 1.3 to 3.6) remained significant in pred icting physician implementation. The logistic model predicting patient adherence to physician-initiated recommendations included male patien t gender (odds ratio 3.1, 95% CI 1.3 to 7.0), the status of the recomm endation of ''most important'' (odds ratio 1.9, 95% CI 1.0 to 3.8), to tal 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 intervention strategies are feasible and lead to high levels of physi cian implementation of and patient adherence to physician-initiated CG A recommendations. These interventions appear to be particularly effec tive in HMO patients and for recommendations that were deemed to be '' most important.''