Comparing various short-form Geriatric Depression Scales leads to the GDS-5/15.

PURPOSE: To compare three published short GDS scales and to identify a valid and reliable short-form alternative to the 15-item Geriatric Depression Scale. DESIGN: Comparative validation study via retrospective chart review of 816 acute care patients in an 830-bed academic medical center in the USA in 2001. METHODS: Data of the 15-item Geriatric Depression Scale, the Mini-Mental State Examination, and demographic data were extracted from medical records after patient discharge. Three scales: the D'Ath GDS-4, van Marwijk GDS-4, and Hoyl GDS-5, were compared to the 15-item Geriatric Depression Scale. RESULTS: The Hoyl 5-item version showed the highest sensitivity (97.9%). Concern for GDS-5 false positives when compared to the 15-item GDS (specificity 72.7%) led to re-ordering the 15 GDS items into a new two-tiered instrument, the GDS-5/15. In this study of 816 older adult inpatients, 60% were screened as "not depressed" using the first 5 items on the GDS-5/15, leaving 40% for continued screening and completion of all 15 GDS items. CONCLUSIONS: A shorter screening tool might encourage more providers to add depression screening to routine health care visits. The GDS-5/15 is an alternative screening tool.

The effects of implementation of the Agency for Health Care Policy and Research urinary incontinence guidelines in primary care practices.

OBJECTIVES: To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI). DESIGN: Group randomized trial, conducted from 1996 to 1997. SETTING: Internal medicine and family medicine community practices. PARTICIPANTS: Forty-one primary care practices, including 57 physicians and their staff and 1,145 patients aged 60 and older. INTERVENTION: Twenty of the 41 primary care practices in North Carolina were randomized to a composite intervention that included a 3-hour continuing medical education accredited course, training in management of UI, patient educational materials, and on-site physician and office support. The remaining 21 practices served as "usual care" controls. Telephone surveys of UI status and quality of life were obtained from 1,145 patients before the intervention. At 1 year, patients and physicians were contacted by telephone and mail to determine the effect of the educational intervention. MEASUREMENTS: Patients completed telephone surveys to assess screening for UI, UI status, treatment interventions, and quality of life. Physicians completed surveys related to UI treatment and practice patterns. RESULTS: Baseline and endpoint telephone surveys were completed by 668 of 1,145 (58%) of patients, who were cared for by 45 physicians (10 internists, 35 family medicine). Physician screening rates for UI were 22% for those patients who did not report UI. UI was reported by 39.5% of patients at baseline, of whom 30% reported being asked about UI by their primary care physician during the study. Rates of assessment and management of existing UI were low in both the control and intervention groups. Additional historical questioning indicated that 54.2% reported that they had ever undergone assessment, including history, urinalysis, or testing, or had had management of their UI by any physician. CONCLUSION: Attempts at increasing screening and management of UI by primary care physicians using the AHCPR standardized guidelines using a multifaceted system of educational and logistical support were not successful. These guidelines may not be the best approach to treating UI in the primary care setting.