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.
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TL;DR: In this paper , the authors conducted a qualitative multi-institutional case study across four universities in Belgium and the Netherlands, triangulated information from semi-structured interviews, document analysis, and observations of educational moments, and gained more insights into residents' motivation to learn complex elderly care.
Abstract: More and more patients need complex care, especially the elderly. For various reasons, this is becoming increasingly difficult. The onus is essentially on family physicians to provide this care and family medicine residency programs should therefore prepare their residents for this task. We know from self-determination theory (SDT) that motivation plays a key role in learning and that in order to boost motivation, fulfillment of 3 basic psychological needs - for autonomy, competence, and relatedness - is crucial. As residents often lack motivation, residency programs face the important challenge to motivate them to learn about and engage in complex elderly care. How to do so, however, is not yet sufficiently understood.We conducted a qualitative multi-institutional case study across four universities in Belgium and the Netherlands. In the period between June, 2015, and May, 2019, we triangulated information from semi-structured interviews, document analysis, and observations of educational moments. Guided by SDT concepts, the analysis was performed iteratively by a multidisciplinary team, using ATLAS.ti, version 8. In this process, we gained more insights into residents' motivation to learn complex elderly care.We scrutinized 1,369 document pages and 4 films, observed 34 educational moments, and held 41 semi-structured interviews. Although we found all the 3 basic psychological needs postulated by SDT, each seemed to have its own challenges. First, a tension between the need to guide residents and to encourage their independent learning complicated fulfillment of the need for autonomy. Second, the unpredictability of complex care led to reduced feelings of competence. Yet, guidelines and models could help residents to capture and apprehend its complexity. And third, family medicine practice, patients, and educational practice, by either satisfying or thwarting the need for relatedness, were identified as key mediators of motivation. By setting the right example and encouraging residents to discuss authentic dilemmas and switch their health care approach from cure to care, educators can boost their motivation.Our study has demonstrated that the degree of perceived autonomy, guidance by the education program, use of authentic dilemmas, as well as involvement of group facilitators can aid the process of motivation.NVMO, ERB number 482.
2 citations
01 Jan 2014
TL;DR: Kocher et al. as discussed by the authors conducted a qualitative study about the effects the media has on rugby players in the United States, and found that traditional media did not play a large role in bringing out new players.
Abstract: Rugby’s Rise in the United States: The Impact of Social Media on an Emerging Sport Benjamin Kocher Department of Communications, BYU Master of Arts In this study, the grounded theory approach was used to conduct a qualitative study about the effects the media has on rugby players in the United States. This study involved in-depth interviews with American-born-and-raised rugby players from the top rugby colleges and universities in the United States. These interviews helped identify the role played by traditional and social media in encouraging new players to begin playing the sport of rugby. Results showed that traditional media did not play a large role in bringing out new players in the United States. However newer, social media played a much larger role. New players also emerged through interpersonal communications with others, usually their friends and family. The media was useful in making rugby more important in the lives of the players once they began playing, and recruiting was bolstered by the use of social media. Other results show that another reason rugby players tend to continue playing is because of the bonds of friendship they build with their teammates.
2 citations
Additional excerpts
...以下も参照 Kennedy ＆ Lingard, 2006）。 本調査では、初期のインタビューから重要な テーマを抜き出して記録しており、それを次に 続くインタビューでの別の質問の土台として用 いている。調査期間中ずっと、質問を再検討し ては修正し、インタビュー対象者間の共通性を 見出そうとした。インタビューにおいて何度も 繰り返し見られたテーマは、著しく欠落している テーマと共に重要事項として具体的に記録した。 インタビュー毎の記録を作成するため、オー ディオ機器による録音も毎回行なった（Adams et al., 2002）。本調査においては、電話での会 話をマイクとアプリを使ってコンピューターに 記録した（Adobe Audition）。これらの記録は Express Scribe というソフトウェアで文字化し た。インタビューした選手たちの本名は明かさな いこととする。その代わり、選手には仮名で登場 してもらった。全てのインタビューの文字化が終 了した後、当該記録を NVivo というコンピュー ターソフトに入力した。インタビューやテキスト 分析で、調査者が共通のテーマを抜き出すための 支援ソフトである（NVivo qualitative data analysis software, 2010）。最初は、インタ ビューから継続比較法で見つかったテーマをグ ループ化した（Dionigi, 2006）。トピックに無 関係な小テーマは使用していない。インタ ビューからテーマを収集し終わった後、次には それらを相互に比較・分析し、これらのアスリー トが何故大学でのスポーツとしてラグビーを選 んだのかについて、より多くのことを知ろうと 努めた。 引用文献xvii...
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...以下も参照 Kennedy ＆ Lingard, 2006）。 本調査では、初期のインタビューから重要な テーマを抜き出して記録しており、それを次に 続くインタビューでの別の質問の土台として用 いている。調査期間中ずっと、質問を再検討し ては修正し、インタビュー対象者間の共通性を 見出そうとした。インタビューにおいて何度も 繰り返し見られたテーマは、著しく欠落している テーマと共に重要事項として具体的に記録した。 インタビュー毎の記録を作成するため、オー ディオ機器による録音も毎回行なった（Adams et al., 2002）。本調査においては、電話での会…...
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...Kennedy, T., & Lingard, L. (2006)....
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...以下も参照 Kennedy ＆ Lingard, 2006）。 本調査では、初期のインタビューから重要な テーマを抜き出して記録しており、それを次に 続くインタビューでの別の質問の土台として用 いている。調査期間中ずっと、質問を再検討し ては修正し、インタビュー対象者間の共通性を 見出そうとした。インタビューにおいて何度も 繰り返し見られたテーマは、著しく欠落している テーマと共に重要事項として具体的に記録した。 インタビュー毎の記録を作成するため、オー ディオ機器による録音も毎回行なった（Adams et al., 2002）。本調査においては、電話での会 話をマイクとアプリを使ってコンピューターに 記録した（Adobe Audition）。これらの記録は Express Scribe というソフトウェアで文字化し た。インタビューした選手たちの本名は明かさな いこととする。その代わり、選手には仮名で登場 してもらった。全てのインタビューの文字化が終 了した後、当該記録を NVivo というコンピュー ターソフトに入力した。インタビューやテキスト 分析で、調査者が共通のテーマを抜き出すための 支援ソフトである（NVivo qualitative data analysis software, 2010）。最初は、インタ ビューから継続比較法で見つかったテーマをグ ループ化した（Dionigi, 2006）。トピックに無 関係な小テーマは使用していない。インタ ビューからテーマを収集し終わった後、次には それらを相互に比較・分析し、これらのアスリー トが何故大学でのスポーツとしてラグビーを選 んだのかについて、より多くのことを知ろうと 努めた。 引用文献xvii Adams, W., McIlvain, H., Lacy, N., Magsi, H., Crabtree, B., Yenny, S., & Sitorius, M. (2002)....
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...継 続的に検証した。これは継続比較法として知ら れる。継続比較とは「データの収集と分析が同 時に行われる」ことを指す（Suddaby, 2006, p634）。比較は理論を発展させるための主たる道 具である（Boeije, 2002）。本調査では、インタ ビューの初期から重要なテーマを記録し、次に 続くインタビューでの別の質問の土台としてそ れを用いた。調査期間中ずっと、質問を再検討 しては修正し、インタビュー対象者間の共通性 を見出そうとした。インタビューにおいて何度 も繰り返し見られたテーマは、著しく欠落して いるテーマと共に重要事項として具体的に記録…...
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Journal Article•
TL;DR: The 5-weekend Care of the Elderly Certificate Course as discussed by the authors is an accredited continuing professional development program for primary care practitioners that focuses on cognitive impairment, gait disorders, mental health and pain management, geriatric medical problems, and failure to thrive.
Abstract: Problem addressed Primary care practitioners have unique clinical challenges in caring for elderly patients and require educational courses that are specifically designed for their needs in caring for this patient population. Objective of program To improve family physicians’ knowledge of and confidence in managing common geriatric problems. Program description The accredited course curriculum is delivered on 5 weekends over approximately 6 months. Each weekend focuses on a different theme including cognitive impairment, gait disorders, mental health and pain management, geriatric medical problems, and failure to thrive. Participants complete written assignments between weekend sessions, which involve self-reflection on how the new knowledge and skills gained through the course will be incorporated in the management of elderly patients in their practices. Conclusion The 5-Weekend Care of the Elderly Certificate Course is an accredited continuing professional development program for primary care practitioners. Preliminary evaluation suggests improvement in participants’ self-rated knowledge of and confidence in managing geriatric problems. Qualitative data show positive changes in clinical practice.
2 citations
TL;DR: Policymakers and medical educators should consider multiple strategies that target the motivators, as well as the barriers to pursuing geriatrics, alongside recruitment strategies alongside motivators and barriers for specializing in geriatrics.
Abstract: ABSTRACT While the barriers to specializing in geriatrics are known, motivators behind why medical trainees choose geriatrics are not as well understood. It is also unknown if recruitment strategies in the literature address these barriers and motivators. The aim of this systematic scoping review is to examine the current literature on recruitment strategies alongside motivators and barriers for specializing in geriatrics. Eligible articles for this scoping review either focused on motivators or barriers among trainees (medical students, resident-physicians, fellows) or recruitment strategies. A scoping search was conducted in MEDLINE, Embase, CINAHL, and PsychINFO. Data was extracted on article characteristics and themes. 88 of 2064 articles were eligible and included. Personal fulfillment emerged as the most common theme for motivators, contrary to prior studies that cite positive role modeling. Financial disincentive remained the most common barrier, followed by limited exposure and “futile” practice. Promising interventions beyond financial compensation include defining geriatrics better, emphasizing the high job satisfaction rates, increasing clinical exposure for medical students, and additional funding for academic centers to recruit academic geriatricians. Policymakers and medical educators should consider multiple strategies that target the motivators, as well as the barriers to pursuing geriatrics.
2 citations
Dissertation•
01 Dec 2015
Abstract: Motivating Human Assets in the Field of Physical Asset Management
2 citations
References
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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.
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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)....
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