HEALTH SERVICES RESEARCH: The Effectiveness and Efficiency of Outpatient Geriatric Evaluation and Management

Abstract

Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.

Successful GP intervention with frequent attenders in primary care: randomised controlled trial

“…13 Christiansen et al undertook a randomised controlled trial that reduced the out-of-hours visits by frequent attenders, but with no relevant results concerning GP consultations. 14 Finally, another group of mostly well-designed intervention studies focused on older patients, but again with both negative 15 and positive 16 results. The present study aimed to assess the effectiveness of a new comprehensive GP intervention for decreasing consultations by frequent attenders.…”

“…10 A common underlying assumption is that if health problems are improved, the need to consult decreases, although findings to support this have been both negative 4,5 and positive. [6][7][8][9][10] Another group of intervention studies [11][12][13][14][15][16] used a comprehensive focus with multi-component interventions, although results were inconclusive, and the interventions tended to be unsuccessful; also, most of these studies had methodological problems. O'Dowd intervened successfully in 'heartsink' patients, most of whom are frequent attenders, although no control group was involved.…”

Standardised assessment of older patients by a nurse in an emergency department

“…Patients not admitted to the hospital, but who need ongoing multidisciplinary care, should be referred to established geriatric outpatient programs. These programs consistently improve outcomes such as physical functioning, psychological health and health-related quality-of-life, and reduce medication usage (despite increased number of diagnoses), hospitalisation, emergency department visits, and need for home healthcare services (Cohen 2002, Reuben 1999, Boult 2001, Burns 1995, Williams 1987, Engelhardt 1996. Furthermore, the most successful programs couple assessment with case management (Roller 1996).…”

Geriatric interventions: the evidence base for comprehensive health care services for older people

“…32 Improvements in patient mental status and morale are also regularly reported, 8,30,32,34,37 as is considerable patient satisfaction. 32,33,38 Not surprisingly, only a handful of studies are able to demonstrate a survival benefit from outpatient GEM interventions. 31,33,39,41 In general, costs associated with outpatient GEM services do not differ significantly from usual outpatient care, 30,33,34,37,42 and may decline with continued implementation of the service, suggesting a possible investment effect.…”

“…In addition to benefits to patient function, outpatient GEM programs may also reduce emergency room use, 38 nursing home and acute-hospital admissions, 30,35,36,[38][39][40] and rates of polypharmacy, despite an increased number of medical diagnoses. 32 Improvements in patient mental status and morale are also regularly reported, 8,30,32,34,37 as is considerable patient satisfaction.…”