Annual visits to patients over the age of 75— who is missed? (original) (raw)
Related papers
Family Practice, 2014
Background. Preventive home visits including comprehensive geriatric assessment for potentially frail older people are increasingly implemented in general practice. It remains unclear how to select older people who benefit most from it. Objectives. To determine which community-dwelling older people benefit most from a comprehensive geriatric assessment by a practice nurse during a home visit in terms of detected problems. Methods. A cross-sectional study in 45 general practices in the Netherlands. Practice nurses visited 562 randomly selected older people (aged ≥ 75 years) and 1180 purposefully selected based on the following criteria: last visit to general practice >6 months ago; partner or child(ren) deceased within past 12 months; cognitive or psychosocial functioning unknown to GP; ≥2 chronic conditions; uses ≥5 medications and/or living alone. Results. Mean age of older people was 82.50 years, 65.50% was female. More problems were detected among women, higher age groups, those living alone and the less educated (all P < 0.001). Overall, more problems were detected in purposefully selected older people than in randomly selected older people (P < 0.001). Selection of older people with ≥2 chronic conditions and those using ≥5 medications resulted in more detected problems in general (both P < 0.05). Conclusion. Although the findings are in favour of purposeful selection, observed differences in detected problems between the two selection procedures are relatively small. GPs should at least target older people with ≥2 chronic conditions, using ≥5 medications, being female, of an older age, living alone and the less educated.
Characteristics of general practice care: What do senior citizens value? A qualitative study
BMC Geriatrics, 2010
Background: In view of the increasing number of senior citizens in our society who are likely to consult their GP with age-related health problems, it is important to identify and understand the preferences of this group in relation to the non-medical attributes of GP care. The aim of this study is to improve our understanding about preferences of this group of patients in relation to non-medical attributes of primary health care. This may help to develop strategies to improve the quality of care that senior citizens receive from their GP. Methods: Semi-structured interviews (N = 13) with senior citizens (65-91 years) in a judgement sample were recorded and transcribed verbatim. The analysis was conducted according to qualitative research methodology and the frame work method. Results: Continuity of care providers, i.e. GP and practice nurses, GPs' expertise, trust, free choice of GP and a kind open attitude were highly valued. Accessibility by phone did not meet the expectations of the interviewees. The interviewees had difficulties with the GP out-of-office hours services. Spontaneous home visits were appreciated by some, but rejected by others. They preferred to receive verbal information rather than collecting information from leaflets. Distance to the practice and continuity of caregiver seemed to conflict for respondents. Conclusions: Preferences change in the process of ageing and growing health problems. GPs and their co-workers should be also aware of the changing needs of the elderly regarding non-medical attributes of GP care. Meeting their needs regarding non-medical attributes of primary health care is important to improve the quality of care.
BMJ, 1998
To describe utilisation of general practitioners by elderly people resident in communal establishments; to examine variations in general practitioner utilisation and estimate the likely impact of the "downsizing" of long stay provision in NHS hospitals. Design: Secondary analyses of the survey of disability among adults in communal establishments conducted by the Office of Population Censuses and Surveys in 1986, and projection to present day. Setting: Nationally representative sample of communal establishments in Great Britain. Subjects: Disabled residents aged 65 or more without mental handicap. Results: Residents with higher levels of disability, disorders of the digestive system, resident in smaller local authority homes or larger voluntary residential homes were more likely to consult a general practitioner. For those who consulted, higher levels of disability and morbidity and residence in a private nursing home or a larger private residential home were all associated with greater general practitioner utilisation. Overall, when residents' characteristics and size of home was controlled for, residents in nursing homes had greater predicted utilisation than those in residential care homes. People who would previously have been cared for in NHS hospitals and are now cared for in nursing homes have high predicted utilisation due to their greater morbidity and disability. Conclusion: The "downsizing" of NHS provision for elderly people has increased demand on general practitioners by 160 whole time equivalents per year in Britain.
The journal of nutrition, health & aging, 2018
Objectives: The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally. Design: Multicenter prospective cohort "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). Setting: Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves). Participants: Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85-100 years). Measurements: Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale). Results: Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables. Conclusion: Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.
Norsk Epidemiologi, 2009
Objectives: Although home health care has been the fastest growing segment of the health care system during the last decades, general practitioners' (GPs') home visiting rates have declined. The aim of this study was to analyse home visits in relation to characteristics of both patients and GPs, the diagnoses, and the drugs prescribed. Methods: A cross-sectional descriptive study in the Norwegian county of Møre & Romsdal. All encounters (90,458) and prescriptions (74,079) issued during two months were recorded. Results: 5.074 home visits were recorded (9.2% of all face-to-face contacts). Home visiting rates were highest for the elderly and for children. Most home visits were for new diagnoses, and 28% took place during weekends. Infections in the respiratory tract comprised the majority of the diagnoses for visiting children, whereas coronary heart disease and heart failure were the most frequent diagnoses for visiting the elderly. Drugs were prescribed during 48.9% of the home visits. General systemic antiinfectives and respiratory drugs comprised 53% of all prescriptions, whereas CNS-drugs comprised another 20%. Doctors' characteristics associated with doing home visits were male gender, young age, GP specialisation, fixed salary, and rural location. Conclusions: Home visiting policy should be more selective. While most children could be adequately taken care of by telephone consultations or consultations in the surgery, home visits should be encouraged for the chronically ill and the housebound.
BMJ Open
ObjectiveTo describe, using data from the Newcastle 85+ cohort study, the use of primary care and other healthcare services by 85-year-olds as they age.DesignLongitudinal population-based cohort study.SettingNewcastle on Tyne and North Tyneside, UK.ParticipantsCommunity dwelling and institutionalised men and women recruited through general practices (n=845, 319 men and 526 women).ResultsContact was established with 97% (n=1409/1459) of eligible 85-year-olds, consent obtained from 74% (n=1042/1409) and 851 agreed to undergo the multidimensional health assessment and a general practice medical records review. A total of 845 participants had complete data at baseline for this study (319 male, 526 female), with 344 (118 male, 226 female) reinterviewed at 60 months. After adjusting for confounders, all consultations significantly increased over the 5 years (incidence rate ratio, IRR=1.03, 95% CI 1.01 to 1.05, P=0.001) as did general practitioner (GP) consultations (IRR=1.03, 95% CI 1.01 ...
Factors associated with the frequency of medical consultations by older adults: a national study
Revista da Escola de Enfermagem da USP, 2020
Objective: To analyze factors associated with the high frequency of medical consultations (five or more consultations) among older adult participants of the National Health Survey - 2013. Method: A quantitative cross-sectional study conducted with data from individuals aged 60 years and over (n = 19,503). The outcome variable came from the question: ‘How many times have you consulted the doctor in the last 12 months? Fifty-seven (57) independent variables were listed. The Waikato Environment for Knowledge Analysis software program was used in the analysis. The data set was balanced and the dimensionality reduction test was performed. The variables which were strongly related to the dependent variable were analyzed using logistic regression. Results: The independent variables listed were strongly related to the outcome variables: female gender, negative self-perception of health condition, inability to perform usual activities for health reasons, diagnosis of chronic disease, seeking...
Assessing the needs of the elderly using unsolicited visits by health visitors
Journal of the Royal Society of Medicine, 1985
Thirty-five percent of patients over 70 years old who received an unsolicited visit by a health visitor were found to have previously unidentified needs. In all, 71% of the 110 patients surveyed were found to have problems involving mobility, communication or caring for themselves. Most of their needs were social ones. It was concluded that unsolicited visiting by health visitors was efficient use of time by members of the primary health care team. Changes in practice administration are suggested to improve access to medical care for elderly patients.