Improving home-based providers’ communication to primary care providers to enhance care coordination

Abstract

Objectives: Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol (‘BRIDGE – BRinging Inter-Disciplinary Guidelines to Elders’) in conjunction with DCM.

Method: In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants’ primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months.

Results: Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants’ depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73–2.3). Participants were satisfied.

Conclusion: Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.

Keywords:

• depression
• collaboration
• social services
• home care

Acknowledgements

We would like to thank Drs Martha Bruce, Richard Kravitz, and Phyllis Panzano for their valuable consultation; collaborators at the Hillsborough County Division of Aging Services; their clients who participated in this study; and the primary care and other providers who collaborated with us to improve participants' care. Portions of this research were presented at the annual meeting of the American Association of Geriatric Psychiatry in March 2013. Regarding conflicts of interest, the first author has received payment in the past to conduct training in problem solving therapy, one component of the depression care management intervention described in this article. The first author received no payments related to this project.

Additional information

Funding

This study was supported by a pilot research grant provided to the first author from the University of South Florida College of Behavioral and Community Sciences.