Effect of training on physician attitudes and practices in home and community care of the elderly.

OBJECTIVES: To evaluate the effectiveness of continuing medical education seminars in changing physician attitudes and practice approaches to the provision of home health care and use of community resources, to increase physician awareness of the needs of homebound older adults, and to teach physicians appropriate medical management in the home.

DESIGN: A quasi-experimental pretest and multiple posttest design.

SETTING: Twenty-six seminars were conducted at medical and specialty society annual meetings in 10 states selected for their high proportion of elderly and minority populations.

PARTICIPANTS: Experimental subjects were a convenience sample of 355 primary care physicians who attended the seminars for which continuing medical education credits were granted. The control subjects were a proportional sample of 249 primary care physicians randomly selected from the American Medical Association Physician Masterfile matched for age, sex, locus of training (United States or abroad), and specialty.

INTERVENTION: A half-day interactive seminar. Participants were given a packet of printed materials that reinforced subject matter presented during the seminar. Core faculty for each state consisted of 2 physicians, a home health nurse, and a case manager who was familiar with community resources; physician faculty were identified by peers as local opinion leaders. All participated in a "train-the-trainer" workshop held at the American Medical Association, Chicago, Ill. Questionnaires were administered to the experimental group before the start of the seminar, immediately following the seminar, and 3 months later. The control group completed baseline and follow-up questionnaires but did not attend the seminars.

MAIN OUTCOME MEASURES: Change in physician attitudes toward providing geriatric home care, the degree to which physicians made accommodations in office practices to better manage care of patients at home, and physician willingness to use community resources.

RESULTS: Compared with preseminar attitudes, participants reported a change in feelings of adequacy to provide home care, as well as changes in office practice, number of home visits, and referrals to community agencies (P=.001). Before and after the seminars, US-educated male physicians were more likely to make home visits than female physicians or international medical graduates. At the 3-month follow-up, male international medical graduates were similar to US-trained male physicians. Regardless of sex or locus of training, having a high proportion (>50%) of Medicaid or minority patients or both is inversely associated with willingness to make home visits.

CONCLUSIONS: The seminars achieved the intended outcomes of bridging the gap in the awareness and provision of geriatric home health care and of producing physician attitude and behavior change.