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Journal ArticleDOI

Primary Care for Elderly People Why Do Doctors Find It So Hard

01 Dec 2002-Gerontologist (Oxford University Press)-Vol. 42, Iss: 6, pp 835-842

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.

AbstractPurpose: 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.

Topics: Health care (60%), Ambulatory care (58%)

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Citations
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Journal ArticleDOI
TL;DR: This work examines less structured interview strategies in which the person interviewed is more a participant in meaning making than a conduit from which information is retrieved.
Abstract: BACKGROUND Interviews are among the most familiar strategies for collecting qualitative data. The different qualitative interviewing strategies in common use emerged from diverse disciplinary perspectives resulting in a wide variation among interviewing approaches. Unlike the highly structured survey interviews and questionnaires used in epidemiology and most health services research, we examine less structured interview strategies in which the person interviewed is more a participant in meaning making than a conduit from which information is retrieved. PURPOSE In this article we briefly review the more common qualitative interview methods and then focus on the widely used individual face-to-face in-depth interview, which seeks to foster learning about individual experiences and perspectives on a given set of issues. We discuss methods for conducting in-depth interviews and consider relevant ethical issues with particular regard to the rights and protection of the participants.

4,443 citations


Journal ArticleDOI
TL;DR: Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers, which may lead to delayed detection of behavior problems.
Abstract: Objectives To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care.

186 citations


Journal ArticleDOI
TL;DR: Benefits and risks in applying member-check when studying healthcare topics are explored, questioning the way it should be performed.
Abstract: Objective Sharing qualitative research findings with participants, namely member-check, is perceived as a procedure designed to enhance study credibility and participant involvement. It is rarely used, however, and its methodological usefulness and ethical problems have been questioned. This article explores benefits and risks in applying member-check when studying healthcare topics, questioning the way it should be performed. Methods We discuss researchers’ experiences in applying member-check, using four examples from three different studies: healthcare-providers’ experiences of working with sexual-abuse survivors; adolescents’ exposure to domestic-violence, and delivering and receiving bad news. Results Methodological and ethical difficulties can arise when performing member-check, challenging the day-to-day researcher-participant experience, and potentially, the physician–patient relationship. Conclusion Applying member-check in healthcare settings is complex. Although this strategy has good intentions, it is not necessarily the best method for achieving credibility. Harm can be caused to participants, researchers and the doctor–patient relationship, risking researchers’ commitment to ethical principles. Practice implications Because participants’ experience regarding member-check is difficult to predict, such a procedure should be undertaken cautiously. Prior to initiating member-check, researchers should ask themselves whether such a procedure is potentially risky for participants; and if anonymity cannot be guaranteed, use alternative procedures when needed.

164 citations


Journal ArticleDOI
TL;DR: The health care experience of people with dementia and their caregivers is a complex and dynamic process, which could be improved for many people, and understanding these experiences provides insight into potential gaps in existing health services.
Abstract: Methods: We searched the electronic data- bases MEDLINE, Embase, PsychINFO and CINAHL to identify relevant articles. We extracted key study characteristics and meth- ods from the included studies. We also extracted direct quotes from the primary stud- ies, along with the interpretations provided by authors of the studies. We used meta- ethnography to synthesize the extracted information into an overall framework. We evaluated the quality of the primary studies using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: In total, 46 studies met our inclusion criteria; these involved 1866 people with dementia and their caregivers. We identified 5 major themes: seeking a diagnosis; accessing supports and services; addressing information needs; disease management; and communica- tion and attitudes of health care providers. We conceptualized the health care experience as progressing through phases of seeking understanding and information, identifying the problem, role transitions following diag- nosis and living with change. Interpretation: The health care experience of people with dementia and their caregivers is a complex and dynamic process, which could be improved for many people. Understanding these experiences provides insight into poten- tial gaps in existing health services. Modifying existing services or implementing new models of care to address these gaps may lead to improved outcomes for people with dementia and their caregivers.

115 citations


Journal ArticleDOI
Abstract: The possible effects of ageist language and ageism on the structure and function of intimate and non-intimate relationships have received significant attention from social scientists. Recent research grounded in communication accommodation theory (Giles, Mulac, Bradac, & Johnson, 1987), the communication predicament model of ageing (Ryan, Giles, Bartolucci, & Henwood, 1986), the communication enhancement model of ageing (Ryan, Meredith, MacLean, & Orange, 1995), and ageing and stereotype research byHummert (1994)and colleagues (Hummert & Mazloff, 2001; Hummert, Shaner, & Garstka, 1995) point toward the numerous consequences of both negative and positive attitudes toward ageing. Focusing specifically on health care settings, this article reviews recent theoretical positions and empirical findings that link ageist language and ageism to these positive and negative social consequences, and offers pragmatic suggestions and directions for future research.

99 citations


References
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Journal ArticleDOI
Abstract: PART ONE: CONCEPTUAL ISSUES IN THE USE OF QUALITATIVE METHODS The Nature of Qualitative Inquiry Strategic Themes in Qualitative Methods Variety in Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications PART TWO: QUALITATIVE DESIGNS AND DATA COLLECTION Designing Qualitative Studies Fieldwork Strategies and Observation Methods Qualitative Interviewing PART THREE: ANALYSIS, INTERPRETATION, AND REPORTING Qualitative Analysis and Interpretation Enhancing the Quality and Credibility of Qualitative Analysis

30,632 citations


Journal ArticleDOI
Abstract: Introduction Getting Started Theoretical Sensitivity The Uses of Literature Open Coding Techniques for Enhancing Theoretical Sensitivity Axial Coding Selective Coding Process The Conditional Matrix Theoretical Sampling Memos and Diagrams Writing Theses and Monographs, and Giving Talks about Your Research Criteria for Judging a Grounded Theory Study

28,942 citations


Journal Article
Abstract: PART ONE: CONCEPTUAL ISSUES IN THE USE OF QUALITATIVE METHODS The Nature of Qualitative Inquiry Strategic Themes in Qualitative Methods Variety in Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications PART TWO: QUALITATIVE DESIGNS AND DATA COLLECTION Designing Qualitative Studies Fieldwork Strategies and Observation Methods Qualitative Interviewing PART THREE: ANALYSIS, INTERPRETATION, AND REPORTING Qualitative Analysis and Interpretation Enhancing the Quality and Credibility of Qualitative Analysis

22,635 citations



Journal ArticleDOI
TL;DR: 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.
Abstract: Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.

2,663 citations


"Primary Care for Elderly People Why..." refers background in this paper

  • ...In the area of practice organization, a number of interventions to facilitate primary care of chronically ill elders have been proposed and a few have been studied (Boult, Boult, Morishita, Smith, & Kane, 1998; Leveille et al., 1998; Schraeder, Shelton, & Sager, 2001; Netting & Williams, 2000; Wagner et al., 1996)....

    [...]