scholarly journals Examining primary care physician rationale for not following geriatric choosing wisely recommendations

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Theresa A. Rowe ◽  
Tiffany Brown ◽  
Jason N. Doctor ◽  
Jeffrey A. Linder ◽  
Stephen D. Persell
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Patient Preferences ◽  
Specific Antigen ◽  
Structured Interview ◽  
Care Physician ◽  
Choosing Wisely ◽  
Clinical Inertia ◽  
Oral Hypoglycemic Medications ◽  
Unnecessary Testing

Abstract Background The objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations. Methods Participants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis. Results Nineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well. Conclusions Though physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.

scholarly journals Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

2014 ◽  
Vol 30 (5) ◽  
pp. 565-571 ◽  
Author(s):  
Terry S. Field ◽  
Jessica Ogarek ◽  
Lawrence Garber ◽  
George Reed ◽  
Jerry H. Gurwitz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician ◽  
Post Discharge

scholarly journals Seeking help for sexual difficulties: findings from a study with older adults in four European countries

2019 ◽  
Vol 17 (2) ◽  
pp. 185-195 ◽  
Author(s):  
Sharron Hinchliff ◽  
Ana Alexandra Carvalheira ◽  
Aleksandar Štulhofer ◽  
Erick Janssen ◽  
Gert Martin Hald ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Help Seeking ◽  
Well Being ◽  
Care Physician ◽  
Professional Help ◽  
The Past ◽  
Multivariable Regression ◽  
Seeking Help ◽  
Sexual Difficulty

Abstract Sexual well-being is an important part of life for many people aged 60 and older. However, older adults often face barriers to seeking and receiving help for sexual difficulties. This study used data from a probability survey (n = 3820) on sexuality and ageing to examine help-seeking in 60–75-year-olds in Norway, Denmark, Belgium, and Portugal. More men (12.2%) than women (6.8%) had sought professional help for a sexual difficulty in the past 5 years. The main reason for help-seeking was that sex was important to the participant and/or their relationship. The main source of professional help was the primary care physician. Of those who had sought professional help, 48% were satisfied or very satisfied with the help received, 31.6% were neither satisfied nor dissatisfied, and 20.4% were dissatisfied or very dissatisfied. Others had sought help from informal sources, particularly partners, friends, or websites. The main reasons for not seeking professional help included not being distressed by the symptoms, and thinking that the difficulty would clear up on its own. Multivariable regression analysis revealed that significant correlates of seeking professional help for women and men were level of distress about the sexual difficulty. With regard to women, those who were married, and/or from Portugal were more likely to have sought help. And regarding men, those who attended religious services were more likely to have sought professional help. These results have important implications for healthcare and can be used to inform the development and delivery of services for older adults who experience sexual difficulties.

scholarly journals Continuity of Care with a Primary Care Physician and Mortality in Older Adults

2009 ◽  
Vol 65A (4) ◽  
pp. 421-428 ◽  
Author(s):  
F. D. Wolinsky ◽  
S. E. Bentler ◽  
L. Liu ◽  
J. F. Geweke ◽  
E. A. Cook ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Care Physician ◽  
Continuity Of Care ◽  
Care Physician

Factors Associated With Discussions Regarding Place of Death Preferences Among Older Japanese: A JAGES Cross-Sectional Study

2020 ◽  
Vol 38 (1) ◽  
pp. 54-61
Author(s):  
Yuki Moriki ◽  
Maho Haseda ◽  
Naoki Kondo ◽  
Toshiyuki Ojima ◽  
Katsunori Kondo ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Place Of Death ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Community Factors ◽  
Factors Associated

In Japan, many adults prefer to die at home; however, few have their preferences actually come true. While discussions regarding place of death preferences (DPDPs) are important for older adults, they are poorly documented. Therefore, we investigated the factors associated with older Japanese men and women having DPDPs. We used cross-sectional survey data collected for the Japan Gerontological Evaluation Study (JAGES). We applied multivariable logistic regression analysis to calculate the odds ratio (ORs) of having DPDPs separately between men (n = 2,770) and women (n = 3,038) aged ≥ 75 years. We considered 17 potential factors associated with having DPDPs, which were classified as either demographic, healthcare, family, or community factors. Among participants, 50.1% had DPDPs: 1,288 men (44.3%) and 1,619 women (55.7%). Older adults, DPDPs were associated with 5 additional factors; e.g. having a primary care physician (ORs = 1.47 [men] and 1.45 [women]), as were those who gave family and friends advice (ORs = 1.26 [men] and 1.62 [women]), and having people who listened to their concerns (ORs = 1.70 [men] and 1.81 [women]). Among men, DPDPs were associated with 3 additional factors; e.g. humorous conversations with their spouse (OR = 1.60). Among women, only one factor—reading newspapers (OR = 1.43) was associated with having DPDPs. Social networks with primary care physicians, family members, and friends may be important factors in promoting DPDPs. These gender-based differences in older adults relating to DPDPs should be considered when developing interventions to promote advance care planning that includes DPDPs.

Abstract 353: Patient and Provider Awareness of Unnecessary Testing, Wasteful Medical Spending, and Choosing Wisely

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
David E Winchester ◽  
Linda Nguyen ◽  
Kristopher Kline ◽  
Jared Plumb ◽  
Tianyao Huo ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Healthcare Providers ◽  
Hospital Medicine ◽  
Choosing Wisely ◽  
Care Hospital ◽  
Care Providers ◽  
Medical Spending ◽  
Primary Care Hospital ◽  
Unnecessary Testing

Background: A substantial portion of medical spending, such as unnecessary cardiac imaging tests, does not benefit patients and is therefore wasteful. While estimates of wasteful spending and unnecessary testing are reported in the literature, the degree to which those facts are known by patients and health care providers is not well described. We conducted a survey of patients and providers awareness about waste and hypothesize that patient awareness will be less than providers. Methods: We developed an anonymous survey for patients and healthcare providers. Recruitment was done in primary care and cardiology clinics, in the nuclear cardiology laboratory, and included sites both at our academic medical center and our affiliated Veterans Affairs medical center. We recruited patients who either have had nuclear myocardial perfusion imaging (MPI) or may have one ordered for them. We recruited healthcare providers who commonly order nuclear MPI from primary care, hospital medicine, and cardiology including both physicians and advanced providers. Survey questions were in a variety of formats including yes/no, scale responses, multiple choice, and narrative. When possible, identical questions were asked of patients and providers. Comparisons between the groups were made by chi square test. Results: The survey was completed by 338 patients and 111 providers. Patients were evenly distributed between primary care (36.0%), nuclear medicine (31.9%), and cardiology (32.2%) recruitment sites, with 55.6% being Veterans. Providers were also well distributed among primary care (37.7%), hospital medicine (22.8%), and cardiology (35.1%). Providers more frequently identified the correct total cost (20.9% versus 10.4% by patients, p<0.0001) and percentage of costs (77.5% versus 39.3% by patients, p<0.0001) of wasteful spending. Patients were less likely than providers to be aware of the Choosing Wisely campaign (2.7% versus 37.2%, p<0.0001). Nearly half (137, 43.5%) of patients indicated that sometimes it is “a bad idea to get a test”; the most common narrative reasons included risk of the test (n=11), lack of symptoms (n=10), and the test not being necessary (n=10). Responses from providers regarding inappropriate reasons to order tests included lack of symptoms (n=26), patient or family demands (n=16), and malpractice fears (n=12). Conclusion: Both patients and healthcare providers underestimate the costs of wasteful medical spending, patients to a greater degree. Awareness in both groups of the Choosing Wisely campaign is low. Many patients and providers are cognizant of accurate reasons why a test might be unnecessary.

scholarly journals Association between Cognitive Decline in Older Adults and Use of Primary Care Physician Services in Pennsylvania

2012 ◽  
Vol 3 (3) ◽  
pp. 201-209 ◽  
Author(s):  
Nicole R. Fowler ◽  
Lisa A. Morrow ◽  
Li-Chuan Tu ◽  
Douglas P. Landsittel ◽  
Beth E. Snitz ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cognitive Decline ◽  
Primary Care Physician ◽  
Care Physician ◽  
Physician Services

Middle-Aged and Older Adult Health Care Selection

2016 ◽  
Vol 36 (4) ◽  
pp. 441-461 ◽  
Author(s):  
Scott R. Sanders ◽  
Lance D. Erickson ◽  
Vaughn R. A. Call ◽  
Matthew L. McKnight
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Older Adult ◽  
Care Physician ◽  
Adult Health ◽  
Middle Aged ◽  
Community Ties ◽  
Local Primary Care ◽  
Adult Health Care

This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the “outshopping theory,” where respondents select services in larger regional economic centers rather than local “mom and pop” providers, now extends to older adult health care selection.

scholarly journals Nurse Practitioner’s Role as 3D Team Leader

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 745-745
Author(s):  
Kathleen Obuchon
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Older Adult ◽  
Home Visit ◽  
Cognitive Vulnerability ◽  
Care Physician ◽  
Intervention Period ◽  
Clinical Assessments ◽  
Inappropriate Medications ◽  
Reconciliation Process

Abstract The nurse practitioner’s (NP) clinical activities during the 12-month intervention period include 4 monthly in-home visits and 8 monthly telephone contacts. This presentation will detail the clinical assessments and activities conducted during the initial home visit, and how subsequent home visit activities and interventions are structured for older adults and their informal caregivers depending on whether older adults have dementia, depression, and/or recent delirium. Because the potential for medication-related problems is a critical concern for older adults with cognitive vulnerability, this presentation also will detail how the NP works with the 3D Team pharmacist to determine potential inappropriate medications through a review and reconciliation process, and how the NP and pharmacist summarize these results and correspond accordingly with the older adult’s primary care physician. Finally, this presentation will explain how the NP manages communication among members of the 3D Team who provide interventions to the same older adult and caregiver.

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