Patient-Centered Approach to Building Problem Solving Skills Among Older Primary Care Patients: Problems Identified and Resolved

Abstract

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues.

Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach

“…This aligns with other research that finds that consultations become more patient-centred when patients are empowered, with time to think and decide on whether to request help, thereby guiding clinicians and indicating their level of ‘readiness’ to participate in decision-making [17, 18]. Evidence indicates that this facilitates improved prioritisation and problem-solving, hence increasing consultation efficiency as well as enhanced patient health and self-management skills [19, 20]. …”

Current Depression Interventions for Older Adults: A Review of Service Delivery Approaches in Primary Care, Home-Based, and Community-Based Settings

“…Other studies have tested PST interventions in the primary care population. Enguidanos and colleagues [29] reexamined data from a randomized control trial that tested a PST intervention delivered by social workers in the primary care setting. Focusing solely on the 107 older adults enrolled in the eight-session PST condition, the researchers aimed to identify the factors related to successful problem resolution.…”

A Role for Social Workers in Improving Care Setting Transitions: A Case Study

“…The aim of PST is not to solve problems for the patient; rather, to teach patients to address their problems and challenges by breaking them down into smaller goals and identifying actions that can be taken to solve them, with the ultimate goal of providing long-term and sustainable self-sufficiency (Enguidanos, Coulourides Kogan, Keefe, Geron, & Katz, 2011; Malouff, Thorsteinsson, & Schutte, 2007; Nezu, 2004). The social worker worked with the patient to identify problems or issues and to develop a plan to address them.…”

“…This coaching was perhaps one of the most essential aspects of this case study: coaching in negotiation skills can give patients self-control and self-efficacy and reduce feelings of helplessness or victimization, leading to better health outcomes (Choi, Marti, Bruce, & Hegel, 2013). Interventions like SWIFT that encourage person-centered self-advocacy, self-management, and problem solving (Coleman et al 2006; Naylor et al, 1999) leads to long-lasting benefits that have proven to reduce rehospitalization, reduce health costs, and improve patient and provider satisfaction (Arbaje et al, 2008; Boling, 2009; Enguidanos et al, 2011; Naylor et al, 1999; Voss et al, 2011). Mrs. S had numerous factors that placed her at high risk for readmission including her ethnicity (Joynt, Orav, & Jha, 2011; McHugh, Carthon, & Kang, 2010); advanced age (Bjorvatn, 2013; Goldfield et al, 2008; Krumholz et al, 1997; Silverstein, Qin, Mercer, Fong, & Haydar, 2008); limited education (Arbaje et al, 2008); Medicare and Medicaid status (Coleman et al, 2004; Hasan et al, 2009); single (widowed) marital status (Arbaje et al, 2008; Garrison, Mansukhani, & Bohn, 2013); and multiple chronic conditions including hypertension, diabetes, and arthritis that caused her to experience severe pain (Bjorvatn, 2013; Coleman et al, 2004; Silverstein et al, 2008).…”