Purpose: We describe and evaluate a 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. Design and Methods: This multifaceted intervention, which was structured after the successful IMPACT (Improving Mood/Promoting Access to Collaborative Treatment) research intervention, used on-site 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 by means of regional training sessions and phone contact. Evaluation data were collected by mail and phone 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, homecare, and public health and social service agencies. Forty-four sites sent 56 staff to Project ADAPT regional trainings, but many did not participate after the initial training. Participants who did continue reported that training improved geriatric depression screening and communication with the primary provider. Implications: Outcomes suggest that provider, patient, and system issues have to be addressed differently in rural areas to improve geriatric depression treatment in primary care settings.
Bibliographical noteFunding Information:
This study was supported by the Health Resources and Services Administration. We thank Robert L. Kane, Anne Kane, Dean Neumann, and others at the University of Minnesota Center on Aging and the Minnesota Area Geriatric Education Center (MAGEC), MAGEC’s regional partners, and Holly Ashmore, Master’s student in Public Health at the University of Minnesota, for their contributions in conducting this project.
With limited funding from the Health Resources and Services Administration, the Minnesota Area Geriatric Education Center (MAGEC) collaborated with its regional partners and IMPACT investigators to implement Project ADAPT in three rural regions of Minnesota. The goal of ADAPT was to develop and implement a pilot program in rural primary care clinics for screening, diagnosis, and treatment of geriatric depression that could be sustained beyond the pilot phase by building the capacity of existing clinic staff. The specific objectives of ADAPT were as follows: to utilize a multifaceted training approach incorporating didactic and experiential learning techniques to improve the knowledge and practice of depression assessment and treatment of primary care providers who care for older adults; to train designated staff from primary care clinics in three rural areas of Minnesota to screen, assess, treat, and manage depression in their older adult primary care patients; to develop a geriatric depression care implementation process that could be easily adapted to the rural primary care sites; and to design and implement an interdisciplinary training program for health professionals about the screening, assessment, and treatment of geriatric depression. These objectives were operationalized in the form of Project ADAPT, and University of Minnesota institutional review for the protection of human subjects was requested. Because no specific patient data with identifying information were submitted to the ADAPT team during the project, approval was granted through an expedited review process.
- Collaborative care
- Mental health
- Primary care clinics
- Rural health care settings