Social Work in Primary Care Intervention

The Social Work in Primary Care Study, a randomized controlled trial to test a social work intervention with frail older adults in primary care, enrolled 321 participants. Patients randomized to the intervention arm (n=160) 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. The intervention was designed to improve patient outcomes and reduce unnecessary healthcare utilization. The study population was a group of home-dwelling older adults with multiple chronic conditions, a recent history of unnecessary hospitalizations, and no more than mild cognitive impairment.

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.

Of the 321 enrolled, 193 are female and 128 are male. Almost 55% are between the ages of 65 and 75; 38% are between 76 and 85 years old; and 7% are older than 86 years of age. Of the sample, 69% are Caucasian, 13% African American, 9% Latino, and 5% Asian/Pacific Islander. Almost half of the subjects (49%) are married and 80% own their own home with almost 98% living alone. The majority of the sample (42%) are living with two chronic conditions while almost 24% have four or more chronic conditions. T-Tests and regression analyses were conducted on all the dependent variables in this study. Results show that satisfaction improved significantly (≤.05) in the 4 months following the PST intervention, but this was not significant at 12 months follow-up. Physical functioning improved significantly (≤.05) at 12 months following the PST intervention; although this was not significant at 4 months follow up. Findings from this study will provide information to better understand (1) the feasibility of incorporating an evidence-based social work intervention in primary care; (2) the effectiveness of PST among a frail, chronically ill older population; (3) how the presence of a social worker in a primary care office contributes to clinical practice; and (4) the ability to generalize evidence-based studies to a broader population.