Australian general practitioner attitudes to residential aged care facility visiting

Abstract

Demographic trends suggest that the sustainability of the general practitioner (GP) Residential Aged Care Facility (RACF) workforce, worldwide and in Australia, is under threat, compromising the ongoing care of chronically ill RACF residents. It is therefore important to ascertain current GP attitudes towards this work, to better understand and hypothesise means of reversing this trend. To this end, during 2014 the views of 26 GPs and GP Registrars working in rural and regional New South Wales, Australia, were captured during focus group discussions and one-on-one interviews. Analysis of the qualitative date revealed that GP attitudes towards RACF visiting fell into five key themes: pleasure, duty, remuneration and logistics, hesitation, and frustration. The data also revealed that the overriding emotion GPs felt about RACF visitation was frustration with the avoidable delays and inefficiencies associated with the work. Despite the pleasure GPs derived from their work in RACFs and their sense of obligation to be involved, their hesitation and frustration was compounded by the work's perceived poor remuneration. This research suggests that the barriers to GP participation in RACF visiting were managerial rather than attitudinal, and that a strategic focus upon improving administrative and logistical support is needed.

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

“…Identifying residents' goals, preferences, needs and values is an important aspect of person‐centred care in RACFs and a key strategy to achieve deprescribing to improve health outcome from medications . Importantly, this study shows that most RACFs do not actively identify and record resident goals and preferences for medications due to a range of factors, which places the responsibility on GPs who are already time poor . Most staff devolved the responsibility to the GP, due to beliefs that it was the duty of the GP and perceptions about professional boundaries.…”

“…17 Importantly, this study shows that most RACFs do not actively identify and record resident goals and preferences for medications due to a range of factors, which places the responsibility on GPs who are already time poor. 18 Most staff devolved the responsibility to the GP, due to beliefs that it was the duty of the GP and perceptions about professional boundaries. Health-care professionals distancing themselves from responsibility and passing it onto others is consistent with previously identified barriers to the optimisation of medications in older adults.…”

Cross-sectional study of Australian medical student attitudes towards older people confirms a four-factor structure and psychometric properties of the Australian Ageing Semantic Differential

“…16 A recent qualitative study of Australian GP's perceptions identified poor remuneration, logistic issues, system inefficiencies and inadequate training as potential obstacles to treating older people in ACF. 17 Review of the relatively sparse literature published on Australian medical student attitudes toward older people found these to be measurably neutral to positive. Findings from qualitative research into student attitudes also captured by the review were mixed, with negative themes of nihilism, paternalism, communication challenge, perceptions of high morbidity and reduced quality of life.…”

“…16 A recent qualitative study of Australian GP’s perceptions identified poor remuneration, logistic issues, system inefficiencies and inadequate training as potential obstacles to treating older people in ACF. 17 …”

A Realist Evaluation of Senior Medical Students' Perspective of a One-Week A Residential Aged Care Facility Clerkship

“…This resource-poor environment may also have to deal with the unrealistic expectations of family members or residents for curative care when a more palliative approach is warranted, as in the care of people with end-stage dementia. The skills to deliver a more appropriate palliative approach may also be lacking (37)(38)(39)(40).…”