Assessing Resident Attitudes and Confidence after Integrating Geriatric Education Into a Primary Care Resident Clinic

Moriarty, John; Wu, Barry J.; Blake, Eileen; Ramsey, Christine M.; Kumar, Chandrika; Huot, Stephen J.; Rink, Andrea; Walke, Lisa M.

doi:10.1016/j.amjmed.2018.03.001

Cited by 6 publications

(6 citation statements)

References 12 publications

(13 reference statements)

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“…In the Netherlands, the GP holds a central role in primary healthcare including care for older patients [ 35 ]. Therefore, it is especially important to educate GPs on the complex care needs of older patients [ 36 ]. However, older patients often need different healthcare services [ 2 ], so case management and hospital care at home would help GPs to reduce ED visits.…”

Section: Discussionmentioning

confidence: 99%

“…After discharge, older patients experienced issues such as untreated health problems, insufficient discharge instructions, inadequate follow-up, and a lack of recovery, which may play a role in future acute care needs and new ED admissions. Given the problems identified in this study, we hypothesize that greater continuity of primary care including the identification of frailty and complex care needs, and an adequate assessment and management of symptoms by the GP or by a health care professional educated in geriatric care, may reduce the onset of crisis, and new ED admissions [ 36 , 37 ]. In addition, comprehensive discharge instructions from the ED, a structured care pathway for patients with multiple chronic conditions, and hospital-at-home interventions may also reduce the onset of new crises and ED revisits [ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

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Older patients’ perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

et al. 2021

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Background Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits. Methods This was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached. Results In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit. Conclusions This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Older patients’ perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

et al. 2021

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“…Previous studies have shown that a good relationship with the GP and greater continuity of primary care reduces ED visits in older patients [28][29][30]. Therefore, it is very important to educate GPs on the complex care needs of older patients [31]. However, older patients often need different healthcare services [2], so case management and hospital care at home would help GPs to reduce ED visits.…”

Section: Discussionmentioning

confidence: 99%

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

Kolk

Kruiswijk²,

Vroomen

et al. 2020

Preprint

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Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

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“…This workshop was a pilot study and could be expanded to additional learners, allowing for further evaluation similar to the work of Moriarty and colleagues. 21…”

Section: Discussionmentioning

confidence: 99%

Geriatrics 5Ms for Primary Care Workshop

et al. 2019

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Introduction The Geriatrics 5Ms provide a novel framework for caring for older adults that directly maps to the current Accreditation Council for Graduate Medical Education (ACGME) core competencies in geriatrics for internal and family medicine residents. Using the 5Ms framework of Mobility, Medications, Mind, Multicomplexity, and Matters Most, we conducted a workshop for residents in a primary care clinic to improve care of older adults. Methods Through Kern's six-step approach to curriculum development, we used our needs assessment and stakeholder interviews to guide development of a half-day Geriatrics 5Ms workshop for residents in primary care. The workshop was piloted with 33 internal medicine residents and included interactive modules and point-of-care tools for each of the Geriatrics 5Ms centered on a longitudinal primary care patient case. Results Initial evaluation of the workshop showed high satisfaction and indicated residents appreciated learning about point-of-care tools for primary care, particularly for cognitive assessment, prognosticating, and deprescribing. Of the learners completing the workshop, 75% reported high self-efficacy ratings (score > 3.5) on the Geriatrics 5Ms domains, compared to only 40% of control learners and 20% of learners completing the preworkshop needs assessment. Discussion A longitudinal, interactive, case-based workshop using the Geriatrics 5Ms framework improved primary care residents' self-efficacy and knowledge of tools in the care of older adults and geriatric competencies outlined by the ACGME. The workshop offers an innovative and efficient method to teach geriatrics to residents in primary care and prepare them to care for an aging population.

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Assessing Resident Attitudes and Confidence after Integrating Geriatric Education Into a Primary Care Resident Clinic

Cited by 6 publications

References 12 publications

Older patients’ perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

Older patients’ perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

Geriatrics 5Ms for Primary Care Workshop

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