Project Adapt: A Program to Assess and Treat Late-Life Depression in Rural Areas

Background and Purpose: Many education and quality improvement interventions to improve screening, assessment and treatment of geriatric depression in primary care have attempted to reduce the gap between evidence and practice but few of these projects have attempted to translate this evidence into rural primary care settings. This paper describes and evaluates a HRSA-funded project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT—Assuring Depression Assessment and Proactive Treatment—utilized existing primary care resources to overcome barriers to sustainability experienced by similar projects.

Methods: This multi-faceted intervention, which was structured after the successful IMPACT research intervention, used onsite geriatric depression specialists, clinic staff training, team collaboration, and depression practice guidelines to improve depression care for rural elders. IMPACT screening and assessment instruments and treatment protocols were modified for use by less highly trained staff already employed by the rural primary care clinics. Patient and provider depression educational materials and depression screening and monitoring protocols were provided via regional training sessions and phone contact. Evaluation data were collected by mail and follow-up telephone surveys.

Results: Although Project ADAPT materials and training were initially developed for providers in rural primary care clinics, most participants came from long-term care facilities, hospitals, home care, and public health and social service agencies. Forty-four sites sent 56 staff from a variety of backgrounds (nurses, social workers, psychologists, physician assistants, certified nursing assistants, and behavioral health specialists) to Project ADAPT regional trainings, but many did not participate after the initial training. Staff from 15 of the 44 sites completed the mail survey and also participated in the follow-up telephone survey. The majority reported earlier identification of geriatric depression and improved communication about depression with the primary provider as a result of participation in Project ADAPT.

Conclusions and Implications: Outcomes suggest that provider, patient and system issues need to be addressed differently in rural areas to improve geriatric depression treatment. This study demonstrated that there is considerable interest in identifying and treating geriatric depression in rural health care settings outside of the traditional primary care clinic. Non-primary care settings may have more system flexibility, more time to spend with individual clients/patients, and more access to regular client/patient contact. Study outcomes also reinforced the need for depression protocols and materials designed to meet the specific needs of individual clinical sites.