Date of Degree

12-2019

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Christopher P. Weidlich

Advisor

Irene C. Gilliland

Abstract

Background: Mental illness remains under-treated in older adults, especially those that are home-bound. In response to access to care gaps, an innovative advanced practice registered nurse led Home-Based Psychiatric Care program was developed as an adjunct to an established home-based counseling agency. The program involves the research supported provision of home-based psychiatric evaluations and medication management by the agency’s PMHNP. Purpose/Objectives: To evaluate the HBPC Program’s effectiveness at increasing access to timely and effective psychopharmacological treatment and management as evidenced by: (a) an increased percentage of referred patients who are being managed by the agency’s PMHNP, (b) a decrease in wait times for psychiatric evaluation, and (c) improvement in Global Clinical Impression-Improvement scale (CGI-I) and Efficacy Index (CGI-E) scores. Intervention: A retrospective program evaluation of the first 3 months (February to April 2019) of the HBPC Program was conducted via the analysis of remotely mined data, collected from the agency's internally shared quality improvement database. Results: At the 12-week mark, 60% of referred patients were being managed by the agency's PMHNP, 13% had been assessed within 10 days, and 33.3% had achieved a CGI-I score of ≤ 3 and an Efficacy Index score of ≥ 1.5. Implications: The initial results are inconclusive, yet promising. If improved outcomes are realized over time, the HBPC program is anticipated to improve this agency's ability to provide psychiatric care to vulnerable home-bound geriatric patients, by serving as an essential bridge that connects the elderly with effective psychopharmacologic interventions.

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