Social Work in Primary Care
Intervention
The
Institute for Geriatric Social Work (IGSW), funded by
The Atlantic Philanthropies, and located at Boston University
School of Social Work is concluding a large study testing
a structured social work intervention within the primary
care setting at Kaiser Permanente in California. Scott
Miyake Geron, Ph.D., IGSW's Director, is the Principal
Investigator of the study, and Bronwyn Keefe, M.S.W.,
M.P.H., IGSW’s Assistant Director, is the Co-Principal
Investigator. The Project Director for the California
site is W. June Simmons, LCSW, who is the President/CEO
of Partners in Care Foundation, and the Research Director
is Susan Enguidanos, Ph.D., MPH, also of Partners in
Care.
This
study employs a randomized controlled trial to test
a social work intervention with frail older adults in
primary care. The intervention is designed to improve
patient outcomes and reduce unnecessary healthcare utilization.
The study population is a group of home-dwelling older
adults with multiple chronic conditions, a recent history
of unnecessary hospitalizations, and no more than mild
cognitive impairment. Master’s-level social workers
located in the primary care offices are conducting the
intervention. At the core of the intervention is the
use of intensive Problem-Solving Therapy (PST), a val
idated behavioral change approach shown to be effective
in treating depression and other psychosocial problems.
This approach emphasizes mutually agreed upon goals
for improving the patient’s health status and promoting
his/her independence. Behavioral change approaches like
PST provide patients with the resources and tools to
manage and maintain their health status, and have been
shown to improve mental health functioning. The study
will compare outcomes for patients randomly assigned
to the social work intervention with outcomes for patients
receiving usual primary care.
To
date, this study has enrolled 258 participants, and
the study end date is December, 2007. Patients randomized
to the intervention arm received up to eight sessions
of Problem-Solving Therapy (PST) or brief, protocolized
care management for those declining to participate in
PST or who experience an emergent crisis. Preliminary
analysis of case records from this study revealed that
this intervention was particularly well suited among
those individuals experiencing either a change in their
health status, such as a newly diagnosed medical condition,
or a life changing event, such as a death of a spouse.
This is reflected in both problems identified by the
patients in PST session and by review of case conference
notes. Some of the most frequently identified problems
included addressing health related behaviors and accessing
information to better manage disease and health conditions,
such as weight loss, exercise, medication and pain management,
and medical appointments and procedures. Thematic analysis
of case conference records revealed that the majority
of patients who had successfully engaged in PST were
confronting a myriad of psychosocial issues such as
loneliness, isolation, a recent loss of a spouse, anxiety,
depression, and stress from caregiving and family pressures.
In addition, many participants recently experienced
a change in their health status, such as a new medical
diagnosis or recurrence of an existing medical problem,
or an emergent medical problem such as recent stroke,
heart attack, fall resulting in a break, or hospitalization.
Results
for more than 150 patients who have completed 4-month
follow-up surveys show that key intervention effects
are in the desired direction, with the biggest impacts
on patient satisfaction and physical functioning. Depression
scores are also lower (by .2 points on the GDS scale)
relative to the usual care control group, but not significantly
so at this point in the study. These results, while
preliminary, support the use of PST with a frail older
population with multiple chronic illnesses.
Key Contact
Bronwyn
Keefe, M.S.W., M.P.H.
Co-Principal Investigator and Research Coordinator,
IGSW
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