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Compliance With Recommendations

Cathy M. Allen, MD; Peter M. Becker, MD; Laura J. McVey, RN, MSN; Constance Saltz, PhD; John R. Feussner, MD; Harvey J. Cohen, MD

JAMA. 1986;255(19):2617-2621.

Abstract
As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n=93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

(JAMA 1986;255:2617-2621)

Author Affiliations
From the Geriatric Research, Education, and Clinical Center (Drs Allen, Becker, Saltz, and Cohen and Ms McVey) and the Health Services Research Field Program (Dr Feussner), Veterans Administration Medical Center, and the Division of Geriatrics, Department of Medicine (Drs Allen, Becker, and Cohen), and the Center for the Study of Aging and Human Development (Drs Allen, Becker, Saltz, Feussner, and Cohen and Ms McVey), Duke University Medical Center, Durham, NC. Dr Becker is now with the Program in Geriatrics, State University of New York at Syracuse.

Footnotes
Reprint requests to the Geriatric Research, Education, and Clinical Center (182), Veterans Administration Medical Center, 508 Fulton St, Durham, NC 27705 (Dr Becker).

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