Outpatient Geriatric Evaluation and Management

Toseland, Ronald W.; O‘Donnell, John C.; Engelhardt, Joseph B.; Hendler, Scott A.; Richie, Jill T.; Jue, Donald

doi:10.1097/00005650-199606000-00011

Cited by 70 publications

(55 citation statements)

References 31 publications

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“…All the other studies that have undertaken geriatric assessment in hospitals or in out-patient departments [19][20][21][22][23][24] and having an additional intervention (e.g. home visits) are otherwise not comparable with our study [25][26][27][28].…”

Section: Geriatric Assessment In General Practice: Is It Worth It?mentioning

confidence: 57%

Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study

2008

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Background: geriatric assessment is a well-established instrument to improve the care of the elderly, but little is known about it in general practice although patients often are known for years. Methods: we used STEP-assessment, an instrument developed by European General Practitioners (GPs), which identifies only problems that can be improved; 37 questions had to be answered by the patient and 4 tests had to be done by the GP. Additionally in the study, GP and patient had to indicate separately which of the problems were seen as relevant and what both accepted to do for improvement. A year later, participating GPs were asked by a not-announced questionnaire to report on improvements and reasons for failure. Results: of the 220 eligible GPs, 45 enrolled a random sample of 894 patients (average age 77 years). In all 7.8 out of 32 possible problems per patient were found. Of those, 1.4 problems were not known to the GP. More than two-thirds of the 'new problems' are perceived as relevant by GP, patient or by both. GPs assessed medical problems and patients assessed social/psychological problems as more relevant. The length and quality of the relationship with the patient was reflected in the number of new problems, with fewer new problems in those well-known. A year later, GPs had offered treatment for 47% of the newly diagnosed problems, with a success-rate of 81%. Conclusion: geriatric screening can detect unidentified problems in general practice. Once detected and dealt with, a high proportion of the undetected problems showed improvement. GPs focussed more on medical, while patients more on psychosocial issues. To increase the outcome of screening, it is necessary to discuss the relevance assessed by the patient.

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Section: Geriatric Assessment In General Practice: Is It Worth It?mentioning

confidence: 57%

Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study

2008

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“…Four studies targeted pa- tients with a specified condition, e.g., asthma, congestive heart failure, diabetes mellitus, or coronary artery disease, 7-10 while five studies targeted patients with heterogeneous conditions, e.g., posthospitalization or geriatric populations. [11][12][13][14][15] Three interventions were supervised by a medical subspecialist, 7,8,11 and six by generalists. 9,10,[12][13][14][15] Two studies were carried out at multiple sites, 9,10 while seven were conducted at single sites.…”

Section: Methodsmentioning

confidence: 99%

Case management programs in primary care

Ferguson

Weinberger

1998

J Gen Intern Med

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To review the impact of case management programs on health care resource use; their impact on patient satisfaction, quality of life, and functional status (patient-centered outcomes); and their cost-effectiveness, we reviewed the English language literature utilizing the following MEDLINE and Health-STAR headings: case management, patient care planning, patient-centered care, disease management, care management, and managed care programs. Bibliographies of relevant articles were also reviewed. Only randomized controlled trials were included. Data were extracted manually from relevant publications and are presented descriptively because formal, quantitative methods were not applicable. Nine studies met our inclusion criteria. Of the seven studies examining case management's impact on health resource use, only two found a positive effect. Both successful programs targeted patients with specified disease conditions and care was supervised by a medical subspecialist. None of the programs targeting general disease conditions or supervised by generalists reported a positive effect. All six studies examining patient-centered outcomes reported a positive impact. These effects were unrelated to the patient's conditions or the study personnel. Both studies examining clinical parameters found a positive impact. Only three studies examined costs; all reported nonsignificant cost savings. While case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to disease condition and specialty training of study personnel. Patientcentered outcomes were often improved upon but at unknown cost. Further multisite clinical trials are needed to define case management's role in our future health care system. KEY WORDS: case management; disease management; care management; patient-centered care; managed care programs. J GEN INTERN MED 1998;13:123-126.

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“…These benefits to functional status are apparent for interventions instituted within the patient' s home, 30,31 through hospital ambulatory clinics, [32][33][34] by Geriatric Day Hospitals 35,36 or by combinations of the latter two. 37 Almost all the reported outpatient programs incorporate longitudinal follow-up and appear to be equally efficacious irrespective of the intervention environment.…”

Section: Outpatient Gem Interventionsmentioning

confidence: 99%

“…32 Improvements in patient mental status and morale are also regularly reported, 8,30,32,34,37 as is considerable patient satisfaction. 32,33,38 Not surprisingly, only a handful of studies are able to demonstrate a survival benefit from outpatient GEM interventions. 31,33,39,41 In general, costs associated with outpatient GEM services do not differ significantly from usual outpatient care, 30,33,34,37,42 and may decline with continued implementation of the service, suggesting a possible investment effect.…”

Section: Outpatient Gem Interventionsmentioning

confidence: 99%

“…32,33,38 Not surprisingly, only a handful of studies are able to demonstrate a survival benefit from outpatient GEM interventions. 31,33,39,41 In general, costs associated with outpatient GEM services do not differ significantly from usual outpatient care, 30,33,34,37,42 and may decline with continued implementation of the service, suggesting a possible investment effect. 42 In summary, although of smaller magnitude than for inpatient GEM interventions, substantial evidence exists for the effectiveness of outpatient GEM interventions in maintaining and/or improving function of community patients, irrespective of the intervention environment.…”

Section: Outpatient Gem Interventionsmentioning

confidence: 99%

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Geriatric interventions: the evidence base for comprehensive health care services for older people

Cordato

Saha²,

Price³

2005

Aust. Health Review

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Specialist geriatric services apply a comprehensive, multidisciplinary evaluation and management approach to the multidimensional and usually interrelated medical, functional and psychosocial problems faced by at-risk frail elderly people. This paper examines currently available data on geriatric interventions and finds ample evidence supporting both the efficacy and the cost-effectiveness of these specialist interventions when utilised in appropriately targeted patients. It is proposed that substantial investment in these programs is required to meet the future demands

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Outpatient Geriatric Evaluation and Management

Cited by 70 publications

References 31 publications

Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study

Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study

Case management programs in primary care

Geriatric interventions: the evidence base for comprehensive health care services for older people

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