Social Work in Primary Care: Results from an Evidence-Based Intervention Study for Older Adults

Background: The majority of older persons who receive health care obtain it in the context of a visit with their primary care provider. In spite of growing recognition of the potential of primary care as a location for early identification and prevention of health and psychosocial problems for frail elders, the prevalence of treatable and undetected mental health and psychosocial problems among the frail elderly is well documented, as are the structural barriers that primary care physicians face in effectively coordinating or providing assistance with psychosocial issues. Common challenges faced by older adults living in the community (reduced physical functioning, depression, transportation, and falls) exacerbate chronic physical problems and cause unnecessary emergency room and hospital visits and premature entry into institutional settings.

Methods: The Institute for Geriatric Social Work at Boston University has completed a randomized controlled trial to test the effectiveness of a project using social workers to integrate primary care and community care while using an evidence-based practice. The intervention utilizes Problem-Solving Therapy which is designed to improve health and psychosocial functioning and reduce depression. Social workers were located in the primary care offices of Kaiser Permanente in CA. Home-dwelling older adults (65+) with multiple chronic conditions, recent hospitalizations, and who were cognitively intact were eligible. Each participant in the intervention group received six to eight sessions of Problem-Solving Therapy that averaged 45 minutes long over a period of six weeks. These meetings were conducted either in-home, at the primary care clinic, or a combination of the two. Upon enrollment in the SW intervention arm, the SW contacted the primary care physician (PCP) and informed him/her of the patients' status. The SW elicits specific medical goals from the PCP and combines these with patient-identified problems identified in the screening assessment and throughout the PST sessions.

Results: Baseline comparisons have been completed between treatment and control groups. There are no significant differences in demographic and dependent variables. Nearly half (48%) live alone, 58% report 3+ medical conditions, 75% report moderate to severe pain, 53% report experiencing anxiety, and 37% have some level of depression. Patient satisfaction improved significantly (≤.05) in the 4 months following the PST intervention, but not after 12 months. Physical functioning in older adults improved significantly (≤.05) at 12 months following the PST intervention. We will present findings from our 4 month and 12 month follow up analysis on depression, functioning, problem-solving skills, and quality of life, as well as case studies.

Conclusion: Older adults can have a myriad of complex issues, whether physical or mental, and are often treated for all ailments by their primary care physicians. Integrating social workers into this setting will result in greater patient and physician satisfaction and will help in addressing the multi-faceted needs of older adults.

Implications: This study will add to the growing evidence base on the effectiveness of social work interventions with frail elders. The integration of social workers in primary care has important policy implications for advancing integrated, collaborative models of care involving social workers.