ADAPT serving geriatric populations in rural communities.

Project ADAPTAssessing 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 IdentificationDesign ADAPT training materialsDevelop 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 inter-disciplinary 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 (June-December 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

Depression Care Specialist•Administer GDS

•Provide Patient Education

•Conduct Patient Follow-Up Interviews

•Communicate Results to Physician

Physician•Assess

•Diagnose

•Develop Treatment Plan

•Inform Depression Care Specialist

ADAPT serving geriatric populations in rural communities.

Project ADAPT Clinic Tools

Geriatric Depression Scale Depression Assessment ToolDepression Treatment ProtocolStart Feeling Better (Patient Education Booklet)PowerPoint Depression EducationTreatment 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 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 projectEstablished 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, GeriatricianMerrie J. Kaas, DNSc, APRN, GeroPsychMargaret Artz, PhD, PharmacistMarilyn Luptak, PhD, Clinical Social

WorkerAnne Kane, MPH, Administrator