Geriatric Medicine: Is It Primary Care?

The shift of power from specialist services to the primary care teams has forced the former to examine the value of their hallowed traditions. In psychiatry, and geriatric medicine, the catchment area is a favoured restrictive practice, enabling demand to be regulated to suit the resources of each team. It is time to decide whether this is a practice to be defended and retained or whether, like many other restrictive practices, it is harmful to the consumer.

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Geriatric Medicine: A True Primary Care Discipline

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1993.tb06471.x ◽

1993 ◽

Vol 41 (10) ◽

pp. 1157-1157 ◽

Cited By ~ 1

Author(s):

Duncan Robertson ◽

Barry J. Goldust ◽

B. Lynn Beattie

Keyword(s):

Primary Care ◽

Geriatric Medicine

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A new political anatomy of the older body? An examination of approaches to illness in old age in primary care

Ageing and Society ◽

10.1017/s0144686x12000293 ◽

2012 ◽

Vol 33 (6) ◽

pp. 964-987 ◽

Cited By ~ 5

Author(s):

SUSAN PICKARD

Keyword(s):

Primary Care ◽

General Practice ◽

Chronic Disease ◽

Disease Management ◽

Old Age ◽

Older Patients ◽

Chronic Disease Management ◽

Geriatric Medicine ◽

Evidence Based ◽

Practice Nurses

ABSTRACTThis paper examines the new approaches to older bodies found within primary care, with the purpose of determining whether they represent a significant disjunction from established approaches in geriatric medicine. A genealogical review of clinical approaches to certain conditions commonly found in old age is undertaken utilising (a) key texts of pioneering British geriatricians and (b) three editions of a key textbook of general practice, published between 1989 and 2009. The discourses and practices established by the Quality and Outcome Frameworks in England are then examined, focusing on evidence-based guidance for these same conditions. Following this excavation of written texts, empirical data are analysed, namely the accounts of general practitioners and practice nurses regarding application of the technologies associated with chronic disease management to older patients. Continuities and changes identified by these practitioners are explored in terms of three specific consequences, namely conceptualising and treatment of older bodies and interaction with patients. The paper's conclusion considers whether these changes are significant enough to warrant describing them as representative of an epistemic rupture or break in the way older bodies are perceived, both in medicine and also in society more generally, and thus of constituting a new political anatomy of the older body.

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GERIATRIC MEDICINE: A TRUE PRIMARY CARE DISCIPLINE

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1993.tb06958.x ◽

1993 ◽

Vol 41 (4) ◽

pp. 459-462 ◽

Cited By ~ 22

Author(s):

John R. Burton ◽

David H. Solomon

Keyword(s):

Primary Care ◽

Geriatric Medicine

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Geriatric Medicine and Primary Care Groups in England

Journal of the American Medical Directors Association ◽

10.1016/s1525-8610(04)70165-6 ◽

2001 ◽

Vol 2 (2) ◽

pp. 76-80 ◽

Cited By ~ 2

Author(s):

P CROME ◽

C BUTTANSHAW

Keyword(s):

Primary Care ◽

Geriatric Medicine ◽

Care Groups

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The Recognition, Assessment and Management of Dementing Disorders: Conclusions from the Canadian Consensus Conference on Dementia

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100001165 ◽

2001 ◽

Vol 28 (S1) ◽

pp. S3-S16 ◽

Cited By ~ 34

Author(s):

C. Patterson ◽

A. Grek ◽

S. Gauthier ◽

H. Bergman ◽

C. Cohen ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Physicians ◽

Clinical Care ◽

Geriatric Medicine ◽

Preventive Health Care ◽

Management Of Complications ◽

Consensus Statements ◽

The Impact ◽

Dementing Disorders

Objective:i) To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements.Options:Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents.Potential outcomes:Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents.Evidence:Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems.Values:Recommendations have been developed with particular attention to the context of primary care and are intended to support family physicians in their ongoing assessment and care of patients with dementia.Benefits, harms and costs:Potential for improved clinical care of individuals with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations.Recommendations:See text.Validation:Four other sets of consensus statements and/or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.Sponsors:Funding was provided by equal contributions from seven pharmaceutical companies and by a grant from the Consortium of Canadian Centres for Clinical Cognitive Research (C5R). Contributions were received from two Canadian universities (McGill, McMaster). Several societies supported delegates to the conference.

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Primary Care Groups and geriatric medicine

Reviews in Clinical Gerontology ◽

10.1017/s0959259800001015 ◽

2000 ◽

Vol 10 (1) ◽

pp. 1-3

Author(s):

Peter Crome ◽

Simon Hill

Keyword(s):

Primary Care ◽

Geriatric Medicine ◽

Clinical Excellence ◽

White Paper ◽

Care Group ◽

Health Improvement ◽

Benjamin Franklin ◽

National Service ◽

The United Kingdom ◽

Care Groups

EditorialIt was Benjamin Franklin who wrote that the only two things that one can be certain of in life are death and taxes. Those of us working in the health service in the United Kingdom would probably want to add change as the third certainty. No one was surprised, therefore, when New Labour, in their first White Paper on health, introduced us to a vocabulary of reforms with their now widely-used initials and acronym. These included HIPs (health improvement programmes), NSFs (national service frameworks), NICE (National Institute for Clinical Excellence), CHI (Commission for Health Improvement) and, to replace fund-holding, a new organization for general practice, the PCG or Primary Care Group.

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The University of Pittsburgh CancerCenter Primary Care Provider Workforce Integration Initiative: An institutional model—Design, process, status, and implications.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.41 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 41-41

Author(s):

G J. Van Londen ◽

Jill Weiskopf Brufsky ◽

Ira Russell Parker

Keyword(s):

Primary Care ◽

Focus Groups ◽

Cancer Care ◽

Information Exchange ◽

Geriatric Medicine ◽

Primary Care Providers ◽

Care Providers ◽

University Of Pittsburgh ◽

The University ◽

Workforce Integration

41 Background: Due to increasing numbers of individuals diagnosed with cancer, a burgeoning cohort of cancer survivors with significant medical co-morbidities, and oncology workforce “supply-demand” challenges, the optimal integration of Primary Care Providers (PCPs) into the comprehensive cancer care paradigm is of timely importance. The objective is to describe those specific planning and implementation issues impacting the establishment of a cancer care delivery model targeting the interface between Oncology and Primary Care. Methods: The University of Pittsburgh CancerCenter PCP Workforce Integration Initiative received authorization to proceed in December of 2014. Immediate actions were then undertaken: 1) Establishment of an “Advisory/Working Group” [Fifteen stakeholders representing the interests of Oncology, Patient Advocacy, Nursing, Primary Care (Family Medicine, Geriatric Medicine, Internal Medicine, and Gynecology); Administration, Information Technology, and Research]; 2) Conduct of focus groups and individual, fact-finding conversations; 3) Programmatic planning of a “pilot” intervention; and 4) Planning of a full-day, continuing medical/nursing education symposium focusing upon the specific training and empowerment needs of PCPs with regard to their evolving roles in the comprehensive cancer care paradigm (November/2015). Results: Focus groups demonstrated an overall acknowledgement of the importance of the issue and a willingness to participate. Specific identification of those unique provider roles and competencies necessary to address a patient’s individual “survivorship” risk profile and the development of a system to best enhance communication and information exchange among the providers and patients were made evident. The results of a survey (knowledge, attitudes, beliefs, and practices) conducted to the attendees of the Symposium will be discussed. Conclusions: To best optimize the interface between Oncologists and PCPs with regard to best practices cancer care, well-planned competency training and “system development” will be necessary.

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