Open AccessPromoting Advance Directives Among Elderly Primary Care Patients
Author(s) -
Wissow Lawrence S.,
Belote Amy,
Kramer Wade,
ComptonPhillips Amy,
Kritzler Robert,
Weiner Jonathan P.
Publication year - 2004
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2004.30117.x
Subject(s) - medicine , odds ratio , intervention (counseling) , family medicine , odds , ethnic group , gerontology , ambulatory , psychological intervention , community health center , confidence interval , directive , health care , logistic regression , nursing , sociology , anthropology , computer science , economics , programming language , economic growth
OBJECTIVE: To determine efficient ways of promoting advance directives among heterogeneous populations of elderly ambulatory patients. DESIGN: One‐year quasi‐experimental trial. SETTING: Five suburban and urban health centers in one region of a large managed care organization. One additional suburban center served as a control site. PARTICIPANTS: Individuals ages 65 and older ( N = 2,120) who were continuously enrolled and had a health maintenance visit with their primary care provider during the study year. INTERVENTION: Physician education (oral and written) and physician and patient prompts to discuss advance directives. MAIN RESULTS: Sixty‐six (7.8%) of patients at the intervention centers completed new advance directives, versus 9 of 1,277 (<1%) at the comparison center ( P < .001). Patients 75 and older were twice as likely (odds ratio [OR], 2.0; 95% confidence limits [CL], 1.2 to 3.3) as those 65 to 74 to file a new advance directive, and the odds were twice as great (OR, 2.6; 95% CL, 1.4 to 4.6) at centers serving communities with median household income over the state median. Gender, recent hospitalization, emergency room visits, and number of chronic conditions were not related to making new directives nor was predominant ethnicity of the center community (African‐American versus white). Adjusted for these factors, the intervention resulted in a 20‐fold increase (95% CL, 10.4 to 47.8) in the odds of creating a new advance directive. Doctors reported barriers of time and unwillingness to press discussions with patients. CONCLUSIONS: A replicable intervention largely targeting doctors achieved a modest increase in advance directives among elderly ambulatory patients. Future interventions may need to target lower‐income patients, “younger” elderly, and more specifically address doctors’ attitudes and comfort discussing advance directives.