Primary Care for Elderly People
The GerontologistPublished 1 December 2002Open access
Wendy L. Adams, Helen E. McIlvain, Naomi L. Lacy, Homa Magsi, Benjamin F. Crabtree, Sharon K. Yenny
Citations131
SJR quartileQ1
SJR score1.82
SNIP1.88
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education, and the voices of these physicians and the model resulting from the analysis can inform change.
Abstract
PURPOSE: Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. DESIGN AND METHODS: We conducted in-depth interviews with 20 primary care physicians. Using an iterative approach based on grounded theory techniques, a multidisciplinary team analyzed the content of the interviews and developed a conceptual model of the difficulty. RESULTS: Three major domains of difficulty emerged: (i) medical complexity and chronicity, (ii) personal and interpersonal challenges, and (iii) administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician's training and personal values, shaped the experience of providing care and how difficult it seemed. IMPLICATIONS: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education. The voices of these physicians and the model resulting from our analysis can inform such change.
Keywords
PsychologyMedicineHealth Professions
Contemporary Sociology A Journal of ReviewsBasics of Qualitative Research: Grounded Theory Procedures and Techniques.
29,422 Citations1992Carolyn Ellis, Anselm Strauss +1 more
Qualitative evaluation and research methods
21,737 Citations1990Michael Quinn Patton
Milbank QuarterlyOrganizing Care for Patients with Chronic Illness
2,900 Citations1996Edward H. Wagner, Brian T. Austin +1 more
The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
PubMedAmbulatory care visits of physician offices, hospital outpatient departments, and emergency departments: United States, 1995.
957 Citations1997Susan M. Schappert
Utilization varied by patient age, sex, and race; Persons 75 years and over had the highest rate of ambulatory care visits; and Females had significantly higher rates of visits to physician offices and hospital outpatient departments than males did.
Nursing ResearchDoing Qualitative Research
955 Citations1995Benjamin F. Crabtree, W. L. Miller +1 more
Journal of General Internal MedicineManaged care, time pressure, and physician job satisfaction: Results from the physician worklife study
418 Citations2000the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), Mark Linzer +10 more
HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings and the data suggest that HMO physicians’ satisfaction with staff, community, resources, and the duration of new patients visits should be assessed and optimized.
Journal of Nursing Care QualityA Survey of Leading Chronic Disease Management Programs: Are They Consistent with the Literature?
379 Citations2002Edward H. Wagner, Connie L. Davis +3 more
Survey and site visits of the chronic disease management activities of 72 programs nominated by experts in the field of chronic illness care were described as being particularly innovative and effective, and the surveys indicated common barriers to further expansion of innovative pilot programs.
Journal of the American Geriatrics SocietyPreventing Disability and Managing Chronic Illness in Frail Older Adults: A Randomized Trial of a Community‐Based Partnership with Primary Care
289 Citations1998Suzanne G. Leveille, Edward H. Wagner +5 more
Effective new strategies that complement primary care are needed to reduce disability risks and improve self‐management of chronic illness in frail older people living in the community.
New England Journal of MedicineSurvival after the Age of 80 in the United States, Sweden, France, England, and Japan
289 Citations1995Kenneth G. Manton, James W. Vaupel
For people 80 years old or older, life expectancy is greater in the United States than it is in Sweden, France, England, and Japan, and this finding suggests that elderly Americans are receiving better health care than the elderly citizens of other developed countries.
JAMAHealth Status, Job Satisfaction, Job Stress, and Life Satisfaction Among Academic and Clinical Faculty
238 Citations1985Lawrence S. Linn
Compared with what is known about the general population, both physician samples seemed equally or more satisfied with their health and their lives.
PubMedA survey of leading chronic disease management programs: are they consistent with the literature?
209 Citations1999Edward H. Wagner, C Davis +3 more
JAMASatisfactions, Dissatisfactions, and Causes of Stress in Medical Practice
208 Citations1979B H Mawardi
Several sources of stress (malpractice suits, having to give up certain aspects of medical work, threats of physical harm, and certain features of peer review) are being expressed that were infrequently mentioned in previous studies.
Mayo Clinic ProceedingsMaking “Time” for Preventive Services
181 Citations1993Thomas E. Kottke, Milo L. Brekke +1 more
Evidence is presented that formal delivery systems for preventive services must be developed if the "time" problem is to be solved, and why preventive-services systems need to be integrated into the current health-services system is reviewed.
JAMAPreparedness for Practice
178 Citations1993Joel C. Cantor
Young physicians generally confirm critiques of medical training noted by scholars and commissions, and health care reform is likely to increase the urgency for remedial action.
Clinics in Geriatric MedicineCOMMUNICATION BETWEEN OLDER PATIENTS AND THEIR PHYSICIANS
171 Citations2000Ronald D. Adelman, Michele G. Greene +1 more
It is concluded that healing in its broadest sense can occur only through a humanistic approach to geriatric care.
Archives of Internal MedicinePhysician Reluctance to Discuss Advance Directives
163 Citations1994R. Sean Morrison
Attention can now be focused on methods to overcome the five barriers studied and thereby enhance the execution of advance directives.
Journal of General Internal MedicinePhysician job satisfaction
130 Citations1997SGIM Career Satisfaction Study Group (CSSG), Julia E. McMurray +8 more
The large group practice survey data supported the key importance of day-to-day practice environment and relationships with patients and physician peers, and focus group data of diverse physician subgroups provided contemporary data on physician job satisfaction.
Annals of Internal MedicineHow Satisfying Is the Practice of Internal Medicine?
102 Citations1991Charles E. Lewis, Deborah M. Prout +2 more
There is growing dissatisfaction with the practice of internal medicine, primarily related to concerns over loss of clinical autonomy, the increase in administrative burdens, the potential loss of income, and the threat of malpractice litigation.
The GerontologistBuilding Bridges Between Families and Nursing Home Staff: The Partners in Caregiving Program
99 Citations1998Karl Pillemer, Carol Hegeman +3 more
The Partners in Caregiving program was created to train staff and family members in communication techniques and conflict resolution skills and through a joint meeting with facility administrators, both groups also have the opportunity to influence facility practices.
Health AffairsPhysicians’ Perceptions of Autonomy And Satisfaction In California
94 Citations1999Michael D. Burdi, Laurence C. Baker
This study compares levels of satisfaction and autonomy among California physicians using data from a 1991 survey of physicians and a 1996 survey of California physicians to measure physicians' perceived freedom to undertake eight common activities that may be threatened by marketplace changes.
Psychotherapy and PsychosomaticsStress and the Practice of Medicine II. Stressors, Stresses, and Strains
71 Citations2010Adam J. Krakowski
The previous hypothesis of the motivation of the choice of medicine as a vocation was explored from the point of view of personality features and responses to stress and the group under study did not show severe psychopathology equal to what has been reported in many other studies.
Archives of Family MedicineTrends in Adult Visits to Primary Care Physicians in the United States
66 Citations1999Randall S. Stafford
Trends in primary care practice reflect changes in society and in the US health care system, including demographic changes, an emphasis on prevention, and the growth of managed care.
The Journals of Gerontology Series AThe Effects of a Collaborative Model of Primary Care on the Mortality and Hospital Use of Community-Dwelling Older Adults
63 Citations2001Cheryl Schraeder, Paul Shelton +1 more
The collaborative primary care model evaluated in this study significantly reduced mortality in the second year, without increasing hospital use, suggesting that a collaborative primary Care team that enhances primary care practice can result in better patient outcomes.
Psychotherapy and PsychosomaticsStress and the Practice of Medicine
61 Citations2010Adam J. Krakowski
The hypothesis of motivation for the choice of medical profession as a vocation was explored from the point of view of personality vulnerability due to reaction formation to the fear of death and resulting compulsivity and results are reported in the current presentation.
Journal of the American Geriatrics SocietyMODELS OF GERIATRICS PRACTICE*: Outpatient Geriatric Evaluation and Management
59 Citations1998David B. Reuben, Chad Boult +4 more
The development and operation of a practical model of outpatient geriatric evaluation and management (GEM) for high‐risk, community‐dwelling older adults is described.
Nursing Administration QuarterlyWhoʼs the Boss? Family/Staff Partnership in Care of Persons with Dementia
47 Citations2000Janet Specht, Lisa Skemp Kelley +4 more
This article provides an overview of family involvement in care intervention and its implementation with African American and Caucasian family members of persons with dementia in nursing home settings.
Medical CareDimensions and Correlates of Physician Work Satisfaction in a Midwestern City
40 Citations1998Ann Bates, Lisa E. Harris +2 more
The modified version of the Scheckler et al instrument is a reliable and valid measure of physician work satisfaction and increases in the market share of managed care have differentially affected the work satisfaction of physicians based on their medical specialty, practice setting, and financial arrangements.
PubMedInnovative healthcare for chronically ill older persons: results of a national survey.
38 Citations1999Chad Boult, Robert L Kane +2 more
The innovative programs surveyed tended to target their services to high-risk patients, use teams of providers to deliver care, designate providers to coordinate multiple components of complex care plans, and shift care from higher- to lower-cost environments and/or redesign the delivery of primary care.
Journal of General Internal MedicineHealth insurance does not guarantee access to primary care
27 Citations1995Samuel Cykert, Grace E. Kissling +2 more
The results suggest that systems of multitiered reimbursement are associated with diminished access for patients insured in the lower tiers.
Medical CareFactors Affecting Primary Care Physician Participation in Medicare
26 Citations1997Peter C. Damiano, Elizabeth T. Momany +2 more
The results suggest that as Medicare reforms are discussed, careful consideration of the impact of these reforms on noneconomic issues is important to ensure adequate physician participation and access for elderly patients through the Medicare program.
The American Journal of MedicineInternal medicine: at the nexus of the health care system in responding to the demographic imperative of an aging population
21 Citations2001William R. Hazzard, Nancy Woolard +1 more
PubMedNeeds for CME in geriatrics. Part 2: Physician priorities and perceptions of community representatives.
19 Citations1996I Pereles, Matthew Russell
Looking at physicians' responses to the needs for education in geriatrics identified by a community needs survey should help physicians recognize the community's needs and design programs that will address them.
The GerontologistPhysician Satisfaction with Career Choices in Geriatrics
18 Citations1990Albert L. Siu, John C. Beck
Satisfaction with a career choice in geriatrics was significantly greater among those physicians who had practices with large numbers of patients over 75, accepted Medicare assignment, spent their time as clinician-researchers, and had a medical school appointment.
Health & Social WorkExpanding the Boundaries of Primary Care for Elderly People
15 Citations2000F. Ellen Netting, Frank G. Williams
The results of a qualitative evaluation of the Generalist Physician Initiative indicate that social workers are logical collaborators with primary care physicians as contemporary practice is expanding to be more holistic.
Academic MedicineASSOCIATION OF AMERICAN MEDICAL COLLEGES
12 Citations1991E D Perez, Terrence Mullıgan +1 more
Findings may help geriatrics educators develop methods to educate primary care providers about geriatrics and may help Geriatrics educators development methods to Educate primary care provider about geriatric education.
Academic MedicineInterest in Geriatrics Education among Family Practitioners and Internists in Virginia
11 Citations1991DAVID E. PEREZ, Thomas Mulligan +1 more
Findings may help geriatrics educators develop methods to educate primary care providers about geriatrics and may help Geriatrics educators development methods to Educate primary care provider about geriatric education.
PubMedPhysician attitudes and behavior in response to changes in Medicare reimbursement policies.
9 Citations1991Geiger Wj, Krol Ra
Ohio primary care physicians have a negative opinion of Medicare reimbursement policies and have limited their practices significantly as a result.
PubMedPhysician responses to Medicare physician payment reform: preliminary results on access to care.
7 Citations1993Lee Dw, Gillis Kd
The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount.
PubMedPhysician responses to Medicare payment reform: an update on access to care.
3 Citations1994D W Lee, Kurt D. Gillis
The results show that the majority of physician-based access indicators did not change significantly from 1992 levels, and those indicators that did change generally offset reductions in access identified immediately after the implementation of Medicare physician payment reform.