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

Received August 12, 1997; accepted January 15, 1998. From the Columbia University-Binghamton Psychiatric Center, Geriatric Psychiatry Fellowship Program, New York State Office of Mental Health. Address correspondence to Dr. Devanand, 722 West 168th Street, Unit 72, New York, NY 10032.

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.

Key Words: primary care • homebound • compliance