337 Evaluation Of Screening Instruments For Recognition Of Disability In Older Patients In General Practice

M. Harris, S. liffe, S. See Tai
Department Of Primary Care & Population Sciences
Royal Free & University College Medical School, London
This study evaluated the use of screening instruments for the recognition of disability in older patients in general practice and tested three null hypotheses.
1. general practitioners do not miss disability in older patients.
2. a brief screening instrument does not perform well against a complex instrument.
3. feedback of the results of disability assessment does not change general practitioners' management of disability
Methods A community survey in three general practices in north west London of community dwelling patients aged 75 and over. The intervention consisted of assessment of disability by one general practitioner comparing a seven item brief screening instrument and the Office of Population Census & Surveys (OPCS) schedule for disability assessment, taken as a ‘gold standard’. Data on disability identified was compared with information in manual and electronic clinical records. Referral for remedial action on disabilities in older people by their general practitioners receiving feedback from the disability assessment was compared with referrals in a ‘normal care’ group.
Results Identification of disability by general practitioners was better than expected, and the assessment tools failed to identify a group of older patients referred by their general practitioner for remedial action because of their disabilities. However, general practitioners also failed to identify some patients found to have disabilities using the assessment instruments. The OPCS schedule fails to identify problems with bathing, and the brief screening instrument showed floor effects and failed to identify unrecognised disabilities of low severity. The general practitioner referral rate for remedial action on disabilities in older people in the disability assessment group was not significantly different compared with normal care.
A group of patients have low severity disabilities that are missed by their general practitionerss, and a screening tool sensitive to them may have potential. However, factors determining the recognition or non-recognition of disability need to be investigated further before any assessment process is introduced into general practice. The brief screening instrument tested appears not to confer advantages over clinical judgement in the assessment of disability in these general practices patients. Assessment of disability does not appear to change general practitioner management.
337 Evaluation of Screening Instruments for Recognition of Disability in Older Patients in General Practice