COMPLIANCE OF FRAIL ELDERLY WITH HEALTH-SERVICES PRESCRIBED AT DISCHARGE FROM AN ACUTE-CARE GERIATRIC WARD

OBJECTIVES. A model of compliance by frail elderly with prescribed hea lthcare services was developed and tested. The discrepancy between pri mary care, geriatric and community health center (CLSC) services presc ribed at discharge after comprehensive geriatric evaluation and treatm ent was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relat ionship was modified by organizational factors, reinforcing factors, a nd changes in health status during the observation period. Intention t o adhere resulted from individual and reinforcing factors existing bef ore discharge. METHODS. This model was tested on 211 patients discharg ed to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health cente r charts. RESULTS. On average, patients used 56.9% of services prescri bed; 13% of patients did not used any of the services prescribed for t hem, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportati on. Intention itself was not found to be an important determinant of o verall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and wit h the geriatric clinic before discharge and communication with the loc al community health center increased overall compliance. Moreover, pat ients who perceived they had access to transportation and to an accomp anying person were more likely to comply. CONCLUSIONS. The results sug gest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance.