A Step toward Solving the Geriatrician Shortage

Hirth, Victor; Eleazer, G. Paul; Dever-Bumba, Maureen

doi:10.1016/j.amjmed.2007.10.030

Cited by 26 publications

(13 citation statements)

References 22 publications

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“…Telemedicine clinical trials and its research base using older adults is uncommon [49]. With the limited number of PCPs and geriatricians [50, 51], partnering with other providers for a brief clinical interaction without ongoing management may be more practical option.…”

Section: Telemedicine and Obesity Health Promotionmentioning

confidence: 99%

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

2017

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BackgroundThe growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity.DiscussionWe describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.ConclusionsRecommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

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Section: Telemedicine and Obesity Health Promotionmentioning

confidence: 99%

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

2017

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“…Population aging is a worldwide phenomenon which arouses great concern among different countries and exerts a heavy burden on the demand for geriatric care (Briggs et al, 2006;Diachun et al, 2006). Subsequently, increasing expectations are put on primary care doctors to shoulder a bigger share of care for patients with common geriatric problems in the community (Hirth et al, 2008). However, not all primary care doctors were adequate to meet these expectations (Turner et al, 2004;Smith et al, 2007), and studies also indicated that undergraduate training in geriatric medicine was insufficient (Keller et al, 2002;Bartram et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the learning outcomes of a year-long postgraduate training course in community geriatrics for primary care doctors

Lam

Chow

Lam

et al. 2011

Archives of Gerontology and Geriatrics

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There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common geriatric problems in the community. This study aims to examine the outcomes of a postgraduate training course in geriatrics for primary care doctors. A questionnaire developed by the research team was sent to the course graduates (years 2001-2007). Ninety-eight replies were received with a response rate of 52.4% (98/187). Difference in the ratings by the respondents before and after taking the course was analyzed using the nonparametric Wilcoxon signed rank test. Most respondents felt more rewarding and had participated more in geriatric care, and the majority had improvement in their communication skills with elderly patients after taking the course. Moreover, the graduates are more confident in diagnosing and managing common geriatric problems, and deciding to which specialty to refer the elderly patients. Of the referrals, there was a significant increase to private geriatricians and a significant reduction to other specialists. The average number of elderly patients seen per day had also increased. However, little change was observed about making nursing home visits, the frequency of which remained low. Many graduates expressed difficulties in conducting nursing home visits.

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“…The United States faces a geriatrician and primary care provider shortage . One commonly cited reason is their lower compensation than for other medical specialties . Reimbursement systems largely favor procedures over longitudinal primary care.…”

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confidence: 99%

Time Providing Care Outside Visits in a Home‐Based Primary Care Program

Pedowitz

Ornstein

Farber

et al. 2014

J American Geriatrics Society

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Background/Objectives Homebound elderly patients with chronic medical illnesses face multiple barriers to care. Primary care physicians (PCPs) devote a significant amount of time to care apart from actual office visits, but there is little quantification of such time by physicians who provide primary care in the home. This article assesses exactly how much time physicians in a large home based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time, as well as patient and provider-related factors that may contribute to that increased time, are considered. Design Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included: length of interaction, mode, nature, and whom the interaction was with for 3 weeks. Setting/Participants MSVD is an academic home-visit program in Manhattan, NY. All PCPs in MSVD (n=14) agreed to participate. Measurements Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Results Data on 1151 interactions for 537 patients were collected. An average 8.2 hours/week were spent providing non-home visit care for a full-time provider. Using the most conservative estimates, 3.6 hours/week was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found among dementia vs. non-dementia patients, new vs. non-new patients, and primary-panel vs. covered patients. Conclusion Findings suggest that HBPC providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care.

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A Step toward Solving the Geriatrician Shortage

Cited by 26 publications

References 22 publications

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

Evaluation of the learning outcomes of a year-long postgraduate training course in community geriatrics for primary care doctors

Time Providing Care Outside Visits in a Home‐Based Primary Care Program

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