Lessons Learned in Geriatric Collaborative Care: What if the Status Quo Just Won’t Budge?

Katherine Buck, MS, LMFT Psychology Intern, University of Colorado SOM, Dept of Family MedicineDoctoral Candidate, Clinical Health Psychology East Carolina University

Dennis Russo, PhD, ABPP Clinical Professor of Family Medicine and Psychology, Head Of Behavioral Medicine,

Department of Family Medicine, East Carolina University Eric Watson, MS

Doctoral Student, Clinical Health Psychology, East Carolina University

Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.

Session #A5c Saturday, October 12, 2013

Faculty Disclosure

We have not had any relevant financial relationships during the past 12 months.

Objectives

• Describe the importance of collaborative care research regarding mental health (depression) outcomes for older adults in medical settings

• Identify challenges to collaborative care research in an inpatient setting with geriatric populations

• Discuss solutions to collaborative care research barriers for geriatric, inpatient populations

Learning Assessment

What percentage of geriatric hospitalizations are due, at least in part,

to depression?

A. 26% B. 39%C. 47% D. 58%

Laudisio, et al (2010)

The Team Clinical Psychologist, RN Clinical Nurse Manager (inpatient

unit), 2 psychology graduate students, RN floor staff, and one undergraduate research assistant

The Mission Project revolving around inpatient geriatrics and

depression How to choose a focus?

Our Team and Our Mission

16% of Geriatric Outpatients diagnosed with depression, but this is likely higher inpatient (Reynolds & Kupfer, 1999)

Geriatric patients with depression Higher rates of illness, higher illness burden, and increased risk of suicide (Levy, 2011)

BUT, we’re not getting all the diagnoses right! (Castel, Shahar, German, & Boehem, 2006; Koenig, H., 2006; Garrard, et al, 1998)

In fact, up to 50% of MDs report diagnostic confusion in geriatric patients.

What others knew …

ECU Dept of Family Medicine Already do some consulting to inpatient unit Full range of behavioral health services as outpatient, including

work in brand new Geriatrics Center

Initial Planning of integrated research Team met several times – at first included RN, clinical psych, and

1 graduate student Grew to include nursing research supervisor for hospital (as

consultant) Graduate student – point person on day to day execution

Beginnings of a collaborative project

Planned procedures RN staff would screen/administer, then Bmed staff would

conduct chart reviews Consent, MINI-Cog, GDS, “Detection” question, Chart review

(demographics, treatment team, past depression dx, current treatment for depression, and assessment of depression)

Examine correlations between various demographic/treatment factors and provider/patient detection

The Study Itself

36 Participants GDS above cutoff – 28.6% Mean age – 73.4 17 C, 19 AA; 10 M, 26 F

Zero SI endorsed by any patient or staff Patient detection correlated with :

Life is empty*** Bored Happy***

Extra High yield questions?

Study Findings

GDS NOT correlated with age, gender, hospital admits GDS WAS correlated with self detection

RN data – not usable

Depression variables (problem list, treatment plan, medication) – indicated some scattered documentation We are capturing it in at least one place (usually) Problem list was key variable (link)

Study Findings

Collaboration – better upfront planning Better buy in from “on the ground staff” Needed “point person” for RN (ie, RN student) Better operational definitions (via chart

abstraction) Unexpected factors

Admission numbers Flu

Technical difficulties (staffing, space, computer) Contingency planning

Lessons Learned

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!