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GPs' perspectives on preventive care for older people: a focus group study
- Authors:
- DREWES Yvonne M., et al
- Journal article citation:
- British Journal of General Practice, 62(604), November 2012, pp.582-583.
- Publisher:
- Royal College of General Practitioners
The aims of preventive care for older people may differ from the traditional targets of preventing diseases or injuries and include the maintenance of independence and wellbeing. This qualitative study explored Dutch GPs' perspectives on preventive care for older people in six focus groups involving a total of 37 GPs. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request. It is when the vitality levels in older people fall that the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these responses, a conceptual model for preventive care for different groups of older people was developed. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline).
Physicians' perspectives on caring for cognitively impaired elders
- Authors:
- ADAMS Wendy L., et al
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.231-239.
- Publisher:
- Oxford University Press
This study aims to develop an in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. In-depth interviews were conducted with 20 primary care physicians in the USA. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis techniques. A patient's impaired ability to provide an accurate history and to participate in self-care hindered the usual process of care, often resulting in greater medical uncertainty and feelings of inadequacy and frustration for the physician. Shifting the goal of care from "curing" the patient's illness to "caring" for the patient's quality of life was also problematic. The doctor–patient relationship changed dramatically as others became involved in care, often with attendant ethical dilemmas related to patient autonomy and the locus of decision making. Many physicians described a deep sense of loss and grief as the personhood of patients faded. The increased complexity and prominent social and emotional issues were difficult to manage in the context of the current model of practice.
Health beliefs and GP consultations by older people: a secondary analysis of the British health and lifestyle survey
- Authors:
- PENDRY Elizabeth, BARRETT Geraldine, VICTOR Christina
- Journal article citation:
- Health Care in Later Life, 3(4), 1998, pp.237-251.
In the UK, the general practitioner (GP) is the main health service contact for older people. The increasing number of older people and a rise in reported morbidity among this group suggest that expenditure on GP services is set to increase. Using the Health and Lifestyle Survey, carried out in the UK in 1991/2, this study aims to examine who consults GPs and why. This analysis looks at the effect of older people's health beliefs on GP consultation rates, in conjunction with health and symptom experience. The findings do not indicate and 'inappropriate' use of GP services by older people. Concludes with the suggestion that it is not merely the presence of symptoms that prompts a consultation but it is the impact these symptoms on the individual's ability to function that is significant.
A survey of older peoples’ attitudes towards advance care planning
- Authors:
- MUSA Irfana, et al
- Journal article citation:
- Age and Ageing, 44(3), 2015, pp.371-376.
- Publisher:
- Oxford University Press
Background: Advance care planning (ACP) is a process to establish an individual's preference for care in the future; few UK studies have been conducted to ascertain public attitudes towards ACP. Objective: The aim of this study was to assess the attitudes of older people in East Midlands through the development and administration of a survey. Design: The survey questionnaire was developed on the basis of a literature review, exploratory focus groups with older adults and expert advisor input. The final questions were then re-tested with lay volunteers. Setting: Thirteen general practices were enrolled to send out surveys to potential participants aged 65 or older. There were no additional inclusion or exclusion criteria for participants. Methods: Simple descriptive statistics were used to describe the responses and regression analyses were used to evaluate which items predicted responses to key outcomes. Results: Of the 5,375 (34%) community-dwelling older peoples, 1,823 returned questionnaires. Seventeen per cent of respondents had prepared an ACP document; of whom, 4% had completed an Advance Decision to Refuse Treatment (ADRT). Five per cent of respondents stated that they had been offered an opportunity to talk about ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Levels of trust were higher for families than for professionals. One-third of the respondents would be interested in talking about ACP if sessions were available. Conclusion: Although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority (17%) had actively engaged. Preferences were for informal discussions with family rather than professionals. (Edited publisher abstract)
Physicians' expectations regarding registered nurses caring for older people living in sheltered housing, retirement homes and group dwellings
- Authors:
- KARLSSON Inger, NILSSON Margareta, EKMAN Sirkka-Liisa
- Journal article citation:
- Journal of Interprofessional Care, 20(4), August 2006, pp.381-390.
- Publisher:
- Taylor and Francis
The aim of this study was to illuminate the meaning of the physicians' expectations regarding registered nurses who are responsible for the care of older people living in sheltered housing, retirement homes and group dwellings. A phenomenological-hermeneutic method was used for the analysis. Twelve physicians from two municipalities in Sweden were interviewed. The naive reading of the interviews characterizes the physicians' expressed views of nurses by using metaphors such as “the extended arm”, “gatekeeper” and “belonging to a no-man's land”. In the structural analysis, explanations of the metaphors are given. The new understanding was that the physicians also expect registered nurses to be able to switch between keeping a distance and being close to older people. When registered nurses have this skill, the physicians have a “we” feeling towards the nurse. The paper provides insights into the physician-nurse relationship, in the context of residential care in Sweden.
Early diagnosis of dementia by GPs: an exploratory study of attitudes
- Authors:
- MILNE A.J., et al
- Journal article citation:
- Aging and Mental Health, 4(4), November 2000, pp.292-300.
- Publisher:
- Taylor and Francis
The capacity of early diagnosis of dementia to facilitate effective treatment and care is well established. Despite the likely influence of attitude on practice, little is known about GP attitudes towards early diagnosis. This study collected attitudinal data, and supplementary commentary, from nearly 60% of GPs in one health authority. The research suggests consistency between belief in the value of early diagnosis and reported practice. Overall, the study found that 40% of GPs hold positive views and 20% hold negative views towards early diagnosis. These views are underpinned by specific 'drivers' and 'barriers'. The study concludes that if GPs are to extend their commitment to early diagnosis, development work needs to focus on investing in the training and resources, which facilitate practice, and challenging attitudinal barriers, which undermine it.
The general practitioner and older people: strategies for more effective home visits?
- Authors:
- CARLISLE Sandra, HUDSON Harriet
- Journal article citation:
- Health and Social Care in the Community, 5(6), November 1997, pp.365-374.
- Publisher:
- Wiley
This article is based on findings from a pilot research funded by the Primary Health Care Development Fund in Scotland. This research confirms that community care changes have not to date effected a significant shift in GP perceptions, which are that the probable destiny of frail older people is to enter some kind of residential setting. Examines how and why GPs label certain patients as a 'problem' and uses this categorisation process to suggest that such patients are seen by GPs as having a 'moral career'. The research identifies a point in the career of the older 'problem' patient at which doctors could usefully refer to other agencies. Suggests a model for communication or collaboration as a way of enabling GPs to continue to provide sensitive and individually appropriate care for frail older patients in collaboration with appropriate others.
A mixed methods study of the experience of older adults with multimorbidity in a Care Coordination Program
- Authors:
- MELLUM Jean Scholz, et al
- Journal article citation:
- International Journal of Care Coordination, 21(1-2), 2018, pp.36-46.
- Publisher:
- Sage
Introduction: Care Coordination Programs are designed to streamline services for older adults with multimorbidity. The Triple Aim, a conceptual model for the design and evaluation of healthcare models, stipulates that a balance of three aims—reducing costs, improving population health, and improving patient experience—are needed for high-quality, value-based care. Research is beginning to show that coordinating care across the continuum of care reduces costs and improves the health of the multimorbid older adult population. Yet little is known about older adults’ experience of care and their overall assessment of interactions with healthcare providers across the length of time of these interactions in a Care Coordination Program. Methods: To gain a deeper understanding of older adults’ experience with a Care Coordination Program, this concurrent mixed methods research study analyzed 201 older adults’ assessment of their chronic illness care using the Patient Assessment of Chronic Illness Care (PACIC+). A subset of 30 older adults also participated in a telephone interview to collect qualitative data. Results: The experience of older adults with multimorbidity in a Care Coordination Program was related to two factors: (1) professional actions and (2) professional attitudes. Actions that improved patients’ experience of care were communication, coordination, and addressing fundamental problems. Professional attitudes that improved their experience of care included being compassionate, knowledgeable and professional, mutually respectful, and positive and encouraging. Discussion: To improve patient experience, Care Coordination Programs must design and measure their efforts related to the actions and the attitudes of their care team, especially primary care physicians and care coordinators. (Edited publisher abstract)
Perceived value of support for older adults coping with multi-morbidity: patient, informal care-giver and family physician perspectives
- Authors:
- NAGANATHAN Gayathri, et al
- Journal article citation:
- Ageing and Society, 36(9), 2016, pp.1891-1914.
- Publisher:
- Cambridge University Press
This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal care-givers and family physicians to understand better the barriers and facilitators of uptake of supportive services that contribute to successful ageing at home. (Publisher abstract)
General practitioners’ assessment of, and treatment decisions regarding, common mental disorder in older adults: thematic analysis of interview data
- Authors:
- STRACHAN Jennifer, YELLOWLEES Gill, QUIGLEY April
- Journal article citation:
- Ageing and Society, 35(1), 2015, pp.150-168.
- Publisher:
- Cambridge University Press
Primary and secondary care services are charged with failing to adequately detect and treat mental disorder in older adults due to the ‘understandability phenomenon’; the belief that mental disorder in old age is inevitable and therefore not worthy of intervention. Quantitative data appear to support this hypothesis but lack the explanatory power of detailed accounts. Nine general practitioners (GPs) participated in group interviews about their assessment and treatment of older patients, and their expectations and experience of referral to secondary care. Resulting transcripts were subject to Thematic Analysis. Respondents recognised the unique features of these clients, and their impact on the detailed, recursive processes of assessment, clinical decision-making and intervention. GPs described confidence in managing most cases of mental disorder, describing the role of secondary care as one of consultancy in extreme or unusual cases. GPs did view mental disorder as commonly originating in adverse circumstances, and queried the validity of pharmacological or psychological interventions in these cases. They did not, however, equate understandability with acceptability, and called for social interventions to be integrated with health-care interventions to tackle the cause of mental disorder in older adults. At a wider level, findings highlight the discrepancy between assumptions about GP attitudes and actions, and their own accounts. At a local level, findings will assist in focusing secondary care service development where need is perceived, into consultancy and training. (Publisher abstract)