Compliance With Disposition to Primary Care Physicians and Psychiatrists in Elderly Homebound Mentally Ill Patients

Abstract

In a naturalistic study, the authors evaluated homebound mentally ill elderly patients as part of a psychiatric outreach team in two rural/semi-urban regions. Of the 80 patients evaluated in the two counties, 15 patients were admitted to nursing homes and were excluded from the analyses of follow-up data. Of the remaining 65 patients, 36 were referred to a primary care physician and 29 to a psychiatrist. The follow-up rate with primary care physicians (75%) was significantly greater than with psychiatrists (41% [P < 0.006]). At 3- to 6-month follow-up by telephone, patients who were compliant showed significantly greater clinical improvement than those who were not compliant (P < 0.0001). Overall, the higher follow-up rate for primary care physicians, compared with psychiatrists, reinforces the importance of educating and training primary care physicians in the diagnosis and management of mental disorders in elderly patients.

Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice.

“…It has been consistently shown that older adults, including elderly African Americans and homebound mentally ill older adults, use specialty mental health services at dramatically lower rates than do younger adults. Currently, the elderly have negative and stigmatizing attitudes toward mental health problems and services; they tend to resist use of traditional mental health services and turn to their primary care physicians (PCPs) when troubled (Black et al, 1998; Demmler, 1998; German, Shapiro, & Skinner, 1985; Habib, Sanchez, Pervez, & Devanand, 1998; Jeste et al, 1999; Swartz et al, 1998; Waxman, Carner, & Klein, 1984).…”