Transcript Designing Geriatric Education Materials for Primary Providers

Project ADAPT
Assessing Depression and Proactive
Treatment
The Minnesota Area Geriatric
Education Center
(MAGEC)
ADAPT serving geriatric populations in rural
communities.
Why Geriatric Depression?
 NIMH estimates one-in-six older adults suffer
from depression.
 Fewer than 10% receive a diagnosis &
appropriate treatment.
 Based on these estimates, more than 89,000
older Minnesotans struggle with depression.
 Financial burden of depression exceeds $43.7
billion annually.
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Clinic Model
SCREEN (all patients >65)
ASSESS (all patients with positive screen)
COUNSEL (patients with depression)
TREAT (willing patients)
FOLLOW (provide ongoing support)
IMPROVE (quality of life improves)
ADAPT serving geriatric populations
in rural communities.
Design ADAPT Materials
Review/Revise Project IMPACT materials
to reflect realities of rural Minnesota
Audience Identification
Design ADAPT training materials
Develop inter-professional ADAPT team
ADAPT serving geriatric populations
in rural communities.
Identify ADAPT Clinical Sites
Select three regions with significant rural
populations in Minnesota
Request RGEC staff identify primary care
clinics within their regions
Invite clinic sites within the selected
regions to send clinic staff (ANPs, RNs,
MSWs, CNAs) to regional ADAPT
training sessions.
ADAPT serving geriatric populations
in rural communities.
Provide ADAPT Training
Trainings held in selected regions
Participants came from multiple clinical
sites, and unexpectedly included staff from
hospitals, nursing facilities, county public
health agencies, and parish nurses.
Half day training session provided by interdisciplinary team about geriatric
depression and Project ADAPT
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Participation
Requirements
 Designate a nurse and a social worker,
psychologist, or medical assistant be trained as
Depression Care Specialists during a four-hour
training session to be held in your region of the
state
 Apply the Geriatric Depression Team model of
care in your clinic for a six-month period (JuneDecember 2004)
 Submit pre and post test evaluation data on the
effectiveness of this model in your clinic setting
ADAPT serving geriatric populations
in rural communities.
Depression Care Specialist
 The Depression Care Specialists (DCS) are
trained to be knowledgeable of all aspects of
geriatric depression. They support the primary
provider through:
- patient education and monitoring of medications,
-
identifying and managing treatment plan (After the
treatment plan is identified by the physician and the
patient)
-
Arranging treatment referrals when appropriate.
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Model
Physician
•Assess
•Diagnose
•Develop Treatment Plan
•Inform Depression Care
Specialist
Depression Care Specialist
•Administer GDS
•Provide Patient Education
•Conduct Patient Follow-Up Interviews
•Communicate Results to Physician
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Clinic Tools
Geriatric Depression Scale
Depression Assessment Tool
Depression Treatment Protocol
Start Feeling Better (Patient Education Booklet)
PowerPoint Depression Education
Treatment Options Materials
ADAPT serving geriatric populations
in rural communities.
Evaluation of Project ADAPT
 Written surveys at 6 months requested
information about the use of ADAPT materials,
and number of patients evaluated for depression
and those with a positive screen who accepted
treatment (n=15 of 44 clinical sites)
 Telephone follow up of written surveys at 10
months requested information about barriers to
ADAPT implementation
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Process
Outcomes
Training attendees were from multiple
locations beyond primary care clinics
Multiple disciplines represented,
including: RNs, LPNs, Social Workers,
Discharge Planners, Senior Service
Coordinators, Psychologists, Physician
Assistants
 Rural clinics too small to designate one person
as a DCS
ADAPT serving geriatric populations
in rural communities.
Project ADAPT Outcomes
 10/15 sites used some ADAPT components; no site reported using all the
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components
5 sites not using any ADAPT materials included 4 primary care clinics
and 1 hospital
135 patients screened using the GDS
– 53 screened positive for depression
• 45 treated for depression; 8 refused treatment
Patient Education Booklet was the most often used component No sites
used the assessment algorithm, treatment and monitoring protocol forms,
documentation and CPT coding guidelines
No agency requested consultation from the ADAPT team or referred
patients to the telephone group therapy
Those sites using the GDS reported that the nurses and social workers
who provided the assessments did not identify themselves as a geriatric
depression specialist nor did they complete the other treatment or
counseling responsibilities of the geriatric depression specialist
ADAPT serving geriatric populations
in rural communities.
Reasons ADAPT has faltered
 Sites have not adopted a multidisciplinary
approach to geriatric depression.
 Providers don’t have time to address a positive
screen at original patient visit
 Patients with positive screens have refused
treatment. (Reasons?)
 The ADAPT tools are not ideal in non-clinic
settings
 A shorter screening tool would make screening
more likely (The 15 item GDS is “too long”)
ADAPT serving geriatric populations
in rural communities.
Positive ADAPT Outcomes
More geriatric patients being screened for
depression
Staff within clinics, facilities and agencies
are more educated and aware of geriatric
depression.
The ADAPT educational materials are
being used to train new staff and educate
patients about depression.
ADAPT serving geriatric populations
in rural communities.
Clinical Implications
Rural needs
– Prevalence
– Inadequacy of available tools/processes
– Education
Team Definition
– Member roles
– Responsibilities
Limitations on treatment options
ADAPT serving geriatric populations
in rural communities.
Research Implications
 Smaller rural geographic region would improve
recruitment and training efficiencies
 More on-going support and training of clinical
staff could improve data collection
 Additional money (grant, insurance) to modify
existing mental health services important
 Need a team to do a research project
 Established vs new partnerships between clinical
staff and research team would strengthen research
process
ADAPT serving geriatric populations
in rural communities.
The Project ADAPT
Training Team
Teresa McCarthy MD, MS, Geriatrician
Merrie J. Kaas, DNSc, APRN, GeroPsych
Margaret Artz, PhD, Pharmacist
Marilyn Luptak, PhD, Clinical Social
Worker
Anne Kane, MPH, Administrator
ADAPT serving geriatric populations
in rural communities.