Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Abstract

OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross‐sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility‐, clinic‐, and team‐level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource‐trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real‐time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.

Factors affecting primary care implementation for older veterans with multimorbidity in Veterans Health Administration (VA)

“…To our knowledge, little is known about factors affecting GeriPACT implementation in VA 19 . Understanding these factors is key, especially given program heterogeneity across VA 19 . Our study fills a critical need and gap in knowledge about how contextual factors can affect the implementation of a specialty PCMH (i.e., GeriPACT) for older adults with complex care needs and MCC.…”

“…There are several noteworthy strengths of our study. To our knowledge, little is known about factors affecting GeriPACT implementation in VA 19 . Understanding these factors is key, especially given program heterogeneity across VA 19 .…”

“… 19 In comparison to general population PCMHs, GeriPACTs have a smaller panel size (i.e., two‐thirds of a general primary care provider's panel capacity) and longer appointments times 15,18 . Further, the team‐based care model that characterizes GeriPACT can be implemented in other health systems by integrating lessons learned from GeriPACT implementation in VA 15,19 . Figure 1 provides an overview of GeriPACT composition 19 .…”

“…Illustration of Geriatric patient‐Aligned Care Team (GeriPACT) team 19 . A GeriPACT is comprised of six core members who share interprofessional knowledge, psychological safety, and a shared sense of urgency to meet the needs of older adults with complex comorbidity in near real time.…”

“…GeriPACT core members (illustrated in gray) augment their expertise with that of extended team (illustrated in green) specialty provider members. Source : Reprinted with permission from Reference 19 [Color figure can be viewed at wileyonlinelibrary.com]…”