EFFECT OF TRAINING ON PHYSICIAN ATTITUDES AND PRACTICES IN-HOME AND COMMUNITY CARE OF THE ELDERLY

Objectives: To evaluate the effectiveness of continuing medical educat ion seminars in changing physician attitudes and practice approaches t o the provision of home health care and use of community resources, to increase physician awareness of the needs of homebound older adults, and to teach physicians appropriate medical management in the home. De sign: A quasi-experimental pretest and multiple posttest design. Setti ng: Twenty-six seminars were conducted at medical and specialty societ y annual meetings in 10 states selected for their high proportion of e lderly and minority populations. Participants: Experimental subjects w ere a convenience sample of 355 primary care physicians who attended t he seminars for which continuing medical education credits were grante d. The control subjects were a proportional sample of 249 primary care physicians randomly selected from the American Medical Association Ph ysician Masterfile matched for age, sex, locus of training (United Sta tes or abroad), and specialty. Intervention: A half-day interactive se minar. Participants were given a packet of printed materials that rein forced subject matter presented during the seminar. Core faculty for e ach state consisted of 2 physicians, a home health nurse, and a case m anager who was familiar with community resources; physician faculty we re identified by peers as local opinion leaders. All participated in a ''train-the-trainer'' workshop held at the American Medical Associati on, Chicago, Ill. Questionnaires were administered to the experimental group before the start of the seminar, immediately following the semi nar, and 3 months later. The control group completed baseline and foll ow-up questionnaires but did not attend the seminars. Main Outcome Mea sures: Change in physician attitudes toward providing geriatric home c are, the degree to which physicians made accommodations in office prac tices to better manage care of patients at home, and physician willing ness to use community resources. Results: Compared with preseminar att itudes, participants reported a change in feelings of adequacy to prov ide home care, as well as changes in office practice, number of home v isits, and referrals to community agencies (P=.001). Before and after the seminars, US-educated male physicians were more likely to make hom e visits than female physicians or international medical graduates. At the 3-month follow-up, male international medical graduates were simi lar to US-trained male physicians. Regardless of sex or locus of train ing, having a high proportion (>50%) of Medicaid or minority patients or both is inversely associated with willingness to make home visits. Conclusions: The seminars achieved the intended outcomes of bridging t he gap in the awareness and provision of geriatric home health care an d of producing physician attitude and behavior change.