The impact on general practitioners of the changing balance of care for elderly people living in institutions (original) (raw)
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General practitioner service provision in residential aged care facilities: 1998-2011
Australasian Journal on Ageing, 2013
To examine the general practitioner (GP) consultation patterns for primary health-care services provided in residential aged care facilities (RACFs) by consultation type. Method: Analyses of service provision and RACF population data for the period 1998-2011. All Medicare-subsidised services provided by GPs across Australia in RACFs were included and categorised by consultation type and by time of service delivery (business or after-hours). Results: Overall service delivery increased from 12 118 per 1000 residents in financial year (FY) 1998-99 to 17 079 per 1000 residents in FY2010-11, a 41% increase. Since FY2007-08, the rate of brief consultations has grown by an average of 20% each year. Delivery of after-hours consultations also increased. Conclusions: The pattern of GP services provided in RACFs has changed substantially over time. To some extent these changes reflect regulatory adjustments; however, the pattern is at odds with the ever-increasing dependence levels of residents.
Models of general practitioner services in residential aged care facilities
2015
BACKGROUND Provision of timely and high-quality general practitioner (GP) services to patients in residential aged care facilities (RACFs) is essential for this group of patients as they have high medical needs. OBJECTIVE The aim of this article is to describe different models for general practice care for patients in RACFs. DISCUSSION Models for general practice services include the Continuity Model, where GPs follow long-term patients; the RACF Panel model, where GPs provide care to several patients in nearby RACFs; the GPs with Special Interest in Residential Aged Care (GPwSI RAC) model, where GPs provide regularly scheduled services to larger groups of patients; the Longitudinal General Practice Team (LGPT) model, where GPs provide team-based care; and RACF-based models of care, where GPs partner with RACFs. Hospital-based models of care have also been developed to provide in-reach services to patients in RACFs during episodes of acute illness. There is limited evidence for whic...
Provision of NHS generalist and specialist services to care homes in England: review of surveys
Primary health care research & development, 2015
The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England...
General practitioner consultations at residential aged-care facilities
The Medical journal of Australia, 2007
To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities (RACFs), and to ascertain how these differ from all GP encounters in Australia as a whole. A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health (BEACH) study, April 2004 to March 2006, comparing RACF consultations (identified by Medicare item numbers) with all BEACH study encounters in Australia. Participants were a random sample of GPs who had claimed at least 375 general practice Medicare items in the 3 months prior to the study. Differences in the characteristics of GPs and patients at RACF consultations, morbidities managed, and treatments provided to patients. Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters; 360/1970 GPs (18.4%) recorded at least one RACF consultation. GPs aged > or = 45 years were more likely to record at least one RACF consult...
The Australasian medical journal, 2015
More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs. To examine GPs' perceptions of barriers to providing care to patients in RACFs. This study was conducted in June 2014 in the Bayside Medicare Local (BML) region in Victoria, Australia; all participants were drawn from this region. Two focus groups (FGs) were conducted. One was for GPs (n=5) that have a specific interest in practicing in RACFs, the other with RACF staff (n=8) representing public, private, and not-for-profit aged care providers. Results were presented to the Royal Australian College of General Practitioners (RACGP) National Standing Committee for General Practice Advocacy and Support for feedback and validation of the findings against national perspectives of the effect of remuneration on the provision of GP services in RACFs. Remuneration pr...
Medical services provided by general practitioners in residential aged-care facilities in Australia
The Medical journal of Australia, 2007
We conducted a literature review to assess the current status of general practitioner services in residential aged-care facilities (RACFs) in Australia and the impact of recent initiatives to enhance access by RACF residents to these services. Of 400 publications identified, 22 were selected as relevant to our study. We also analysed publicly available statistical data on GP services in RACFs. Recent initiatives to improve quality of care and facilitate access to GP services for RACF residents include the Aged Care GP Panels Initiative, the Enhanced Primary Care program, and an expanded role of palliative care. Despite these initiatives, many GPs still find RACF services unappealing due to a perceived poor level of remuneration for the effort involved. Further improvements in access to and quality of GP services to RACFs may require new models of care delivery and financing.
Access to general practitioner services: the disabled elderly lag behind in underserved areas
European Journal of Public Health, 2005
Background: Several studies have shown that people living in areas underserved in physicians have reduced odds of consulting. However, beyond the magnitude of this effect averaged for the whole population, policymakers need to know whether specific subgroups faced with transportation difficulties, such as the elderly and especially the disabled elderly, have a particularly restricted access to physicians when residing in underserved areas. Methods: The study sample, representative of the French population aged 18 -75 in 1999, comprised 12 405 individuals. Multilevel Poisson models were used to investigate the impact of the area-level density of general practitioners (GPs) on the number of GP consultations reported over the previous 12 months. Results: The mean number of GP consultations over the previous 12 months was 3.8 (S.D. ΒΌ 4.9). Multivariate analyses indicated that living in areas underserved in GPs lead to a greater reduction in primary care utilization for the elderly, and especially for the disabled elderly, than for younger age groups. The disabled elderly had 244% more GP consultations (95% CI:+79%, +562%) when they lived in areas with high versus low GP density (defined with the 10th and 90th percentiles as cut-offs). Conclusion: If further research confirms our findings, this increasingly disturbing public health issue in industrialized countries where populations are ageing will require priority policy measures. Ensuring that elderly people living in underserved areas have adequate access to primary care may prevent future hospitalizations, use of home care services and institutionalization.
Access to health care in nursing homes: a survey in one English Health Authority
Health & Social Care in the Community, 2000
The objective of the study was to establish the arrangements for provision of general practitioner (GP), nursing advice, chiropody, physiotherapy and speech and language services to nursing homes and to establish the charging policies for those services. To this end a telephone survey of the managers of the 51 nursing homes registered with one English health authority, Merton, Sutton and Wandsworth Health Authority, was undertaken. Forty-nine homes (96%) with 1541 residents responded. Twenty per cent of homes had no regular GP visits and half the homes had no planned medication reviews. One in five homes (27% of residents) had access to all health-care services. Eight homes (10% of residents) did not have access to therapy services or nursing advice. Thirty-three homes used private or both private and NHS chiropody services and 16 homes used the NHS service only. Seventeen homes used private or both private and NHS physiotherapy services with 10 homes receiving a regular private service. Twenty homes used the NHS service and 12 homes (15% of residents) had used no physiotherapy service. None used private speech and language services. Twenty-four of the 33 homes using private chiropody charged extra for this service compared with two of 10 homes using regular private physiotherapy. The findings suggest that there are inequalities in access to health care services in nursing homes. Moreover, there has been a deterioration in access to and levels of provision of NHS nursing and physiotherapy services since the national survey undertaken by the Office Population Censuses and Surveys (OPCS) in Great Britain in the mid-1980s. The new regulatory framework for older people must include systems for monitoring the provision of health services.
Working with Older People, 2011
It is therefore unsurprising that GPs, faced with substantial growth in the number of homes caring for people with complex healthcare needs, or occasional but unpredictable requirements, should express concern about their capacity to provide an adequate service. In some cases this led to demands by GPs for care homes to pay a retainer fee to enable them to provide a service to the home. To date, there has been no systematic study of the prevalence of such charges being sought or paid, but the issue attracted the attention of the House of Commons Health Select Committee during the course of an inquiry into elder abuse (2004). Responding to the report, the government