MANAGING GERIATRIC SYNDROMES - WHAT GERIATRIC ASSESSMENT TEAMS RECOMMEND, WHAT PRIMARY-CARE PHYSICIANS IMPLEMENT, WHAT PATIENTS ADHERE TO

OBJECTIVES: To evaluate the responses of primary care phy---- sicians and patients to recommendations from a commmunity-based comprehensive geriatric assessment (CGA) program for management of four target condi tions: falls, depression, urinary incontinence, and functional impairm ent. DESIGN: Case series. SETTING: Senior centers, meal sites, senior housing, and other community sites as screening locations; and a commu nity-based academic practice as the location for CGA. PARTICIPANTS: A total of 150 older patients living in the community who have one or mo re of the four target conditions and who received CGA MEASUREMENTS: Ph ysician implementation and patient adherence rates were ascertained du ring a face-to-face structured interview with the patient 3 months aft er CGA. RESULTS: Two hundred twelve of 528 (40%) CGA recommendations w ere clearly or possibly related to the target or target-related condit ions. Of these 212 recommendations, 59% required a physician's order f or implementation. The remaining 41% were patient self-care recommenda tions. Overall physician implementation across conditions was 70%; imp lementation rates were highest for falls and lowest for functional imp airment. Overall patient adherence rate was 85% for physician-implemen ted recommendations and 46% for self-care recommendations. Patient adh erence to recommendations for counseling or support groups and exercis e programs was particularly low. CONCLUSIONS: When examining the proce ss of care of community-based CGA, patient as well as physician adhere nce must be considered. Although patient adherence to physician-initia ted recommendations was high for all conditions, it varied substantial ly across target conditions and types of recommendations for self-care recommendations.