Wisconsin Geriatric Psychiatry Initiative

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					Mental Health & Older Adults:
  The Wisconsin Geriatric
 Psychiatry Initiative (WGPI)
              &
       “Star” Method

       Linda Buel RN
          May 8, 2009

                                1
                 Overview

   The public health crisis
   Introduction of WGPI & the Star method
   Early results
   Outcomes measurement plan
   Reach



                                             2
            Issues – now and in 2030
    Population aged 65 and older will increase from
     20 million in 1970 to 69.4 million
    Older adults with mental illness will increase
     from 4 million in 1970 to 15 million
    Ratio of Geropsychiatrists to older adults -
     1:11,451 to 1:20,195


Jeste, Alexopoulus, Bartels, et al., 1999
Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"
                                Consequences
   compromised quality of life
   increased morbidity and mortality- increased
    service visits, increased burden to medical care
    providers, and heightened annual costs of care.
   premature nursing home placement
   preventable hospitalizations

Bartels Stephen J, Michael A. Smyer, Mental Disorders of Aging: An Emerging Public Health Crisis?
      Wisconsin Geriatric Psychiatry Initiative:
    Addressing Complexity in the Face of Scarcity

   Goal:
        to enhance the delivery of mental health services to
         older adults in Wisconsin
   Methods:
        indirect care via case-based consultative teaching
         sessions, using the Star Method
        more widely disseminate principles of geriatric
         psychiatry to different groups of providers:
              health care: medical and psychiatric
              long-term care
              aging network
        network weaving: shaping an infrastructure via the
         strength of weak ties
     Dr. Tim Howell

                                                                5
           Determinants of Health



                            (




Evans and Stoddart, 1990)



                                    6
  Understanding & Addressing Geriatric
               Problems:
     The Wisconsin “Star” Method
                  Medication
                   Issues



 Social                             Medical
 Issues                              Issues
                   Symptom,
                    Problem




Personal Issues                Psychiatric
 (Personality)                   Issues
                                              7
      Early Results - 1

Community Health Partnership report
            Patient

        Dates of Service

      Date of consultation

         Activity before

          Activity after



                                      8
      Early Results - 2

Community Health Partnership report
         Patient Issues

          Team Issues

      Organization Issues

      CT Session results

     Changes after consult
                                            Outcomes

BEFORE & AFTER SESSION

Specific to this case how would you rate (the team) in the
    following:                                               -2   -1   0   1   2
Insight
Enthusiasm
Clarity
Motivation
Understanding

Professional comfort re: how team is working

Professional comfort re: this current situation

Level of hope about this member
Level of hope about his situation


                                                                                   10
                                       Outcomes


To what extent do you agree that the                          neither
results of the Star Method affect       disagree   disagree   agree or   agree      agree
patients':                              strongly   slightly   disagree   slightly   strongly


quality of life


self-reported health status


physical function


emotional function




                                                                                               11
                       Reach
   Milwaukee: CCO (PACE/Partnership/Family Care),
    Aurora Geriatrics, & ALM (CBRF)
   Madison: Care Wisconsin, Family Services
   Eau Claire: CHP (Partnership/Family Care)
   AGS website: www.americangeriatrics.org
   San Antonio & Galveston TX (U Texas), Columbia MO
    (U Missouri), Rochester MN (Mayo), Baltimore MD
    (Johns Hopkins), & Milwaukee (MCW): geriatric
    medicine fellowship programs (by speaker phone from
    Aurora Geriatrics)
Dr. Tim Howell




                                                          12
             Acknowledgements
   Tim Howell, MD, MA; WGPI
    Geriatric Psychiatrist
    Associate Professor, UW Dept of Psychiatry

   Cathy Swanson-Hayes - DHS
   Other members of the WGPI coalition

   University of Wisconsin Hospital & Clinics




                                                 13

				
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