Primary Care for Elderly People Why Do Doctors Find It So Hard
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.
Citations
More filters
DOI•
18 Nov 2019
TL;DR: In this article, the authors used opinion mining and in-depth interview to collect the data from Female Daily Network users opinion and found that keywords that have been written by users on Female Daily Platform are appeared to be different with respondent's relevant keywords from indepth interview.
Abstract: The growth of cosmetics industry in Indonesia shows a good increase align with country’s thriving number of middle-class consumers in 2017 Cosmetics industry reached an impressive growth of 1199% in 2017 The problem is local brand foundations are still facing difficulties to compete and gain bigger market share Big global brands like Unilever still wins overall market share since they grab 70% market share of Indonesia’s cosmetics market This re-search aims to find the factors influencing consumers in choosing foundation This research used opinion mining and in-depth interview to collect the data from Female Daily Network users opinion The result indicates that keywords that have been written by users on Female Daily Platform are appeared to be different with respondent’s relevant keywords from in-depth interview The findings of this research are expected to gives an insightful knowledge of consumers’ preference towards foundation to be useful information generat-ing the right decision making in marketing and new product development
3 citations
Cites background from "Primary Care for Elderly People Why..."
...Whereas the unstructured interview is conducted in conjunction with the collection of observational data, semi-structured interviews are often the sole data source of a qualitative research project (Adams & Mcvillan, 2002)....
[...]
09 Dec 2020
TL;DR: The number of older people living in urban environments is growing dramatically as mentioned in this paper and adhering to a set of standards is essential to achieve a desirable living setting. In order to assess strengths and...
Abstract: The number of older people living in urban environments is growing dramatically. Adhering to a set of standards is essential to achieve a desirable living setting. In order to assess strengths and ...
3 citations
Cites background from "Primary Care for Elderly People Why..."
...Moreover, acute care services for older people such as hospital and physician care have a major impact on use of both acute and long-term care services (Adams et al., 2002; Alley et al., 2007; Hutchison et al., 2011)....
[...]
01 Jan 2010
TL;DR: This chapter targets four major areas that can benefit both research and clinical professionals working with older adults: prevalence, impact, and correlates of the substance abuse in this population; screening and identification; use of brief interventions to either encourage behavior change or facilitate treatment entry, if needed; and treatment research and related issues.
Abstract: Substance misuse, abuse, and dependence in older adults present unique challenges in terms of recognition, interventions, and treatment. These problems are often not recognized and, if recognized at all, are under-treated. Older adults with problems related to alcohol/medication/drug misuse are a special and vulnerable population that can benefit from elder-specific intervention and treatment strategies. Additionally, there are concerns in the field that the standard diagnostic criteria for abuse/dependence are difficult to apply to older adults, leading to under-identification and treatment. This chapter targets four major areas that can benefit both research and clinical professionals working with older adults: (1) prevalence, impact, and correlates of the substance abuse in this population; (2) screening and identification; (3) use of brief interventions to either encourage behavior change or facilitate treatment entry, if needed, and (4) treatment research and related issues. With changing demographics and the aging of the “Baby Boom” cohort, developing brief, cost-effective methods to work with older adults who are experiencing problems related to their use of alcohol, medications, and illicit drugs is a crucial issue for the health care system in the next 20 years.
3 citations
Dissertation•
01 Jan 2017
TL;DR: The role of the pharmacist in optimising prescribing in community-dwelling older adults and the importance of awareness and follow-up in patients with dementia is examined.
Abstract: Title The role of the pharmacist in optimising prescribing in communitydwelling older adults Author(s) O'Riordan, David Publication date 2017 Original citation O'Riordan, D. 2017. The role of the pharmacist in optimising prescribing in community-dwelling older adults. PhD Thesis, University College Cork. Type of publication Doctoral thesis Rights © 2017, David O' Riordan. http://creativecommons.org/licenses/by-nc-nd/3.0/
2 citations
Cites background from "Primary Care for Elderly People Why..."
...Contextual conditions such as the practice environment and the GPs’ training and personal values also influenced the care for these patients (157)....
[...]
TL;DR: The Sunfrail-tool (ST) as mentioned in this paper is a 9-item questionnaire, which is a promising instrument for screening frailty, and it can guide a second-level assessment to key frailty domains and clinical pathways.
Abstract: One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs’ answers were obtained from the patient’s clinical information. A patient was considered frail if at least one of the CGAs’ tests resulted positive. The ST was associated with the CGA’s judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591–0.791). Each CGA’s test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA’s tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766–0.918), a proxy of the risk of falling. The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. The ST is a valid and easy-to-use instrument for the screening of frailty.
2 citations
References
More filters
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
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
31,305 citations
TL;DR: In this article, the authors discuss the uses of literature and open coding techniques for enhancing theoretical sensitivity of theoretical studies, and give guidelines for judging a grounded theory study.
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
28,999 citations
Journal Article•
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
22,714 citations
21,313 citations
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.
2,805 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)....
[...]