Assessing and Addressing Family Caregivers' Needs and Risks in Primary Care

Abstract

Objectives To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. Design Cross‐sectional, national mail‐based survey. Setting American Medical Association Masterfile database. Participants U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62). Measurements Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments. Results Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type. Conclusions Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.

Family Caregiver Assessment in Primary Care: How to Strengthen the HealthCare Triad?

“…Evidence from previous surveys of primary care physicians regarding their dementia care referral practices demonstrates persistently low rates of referral to community resources 12,13 . These results, coupled with physicians in the current study reporting that easier referral mechanisms would facilitate greater attention to caregiver needs, 10 strongly suggest that the growing list of efficacious interventions offering meaningful benefits that cannot be easily offered in the outpatient medical setting to caregivers of older adults, especially those living with dementia, 14 would be attractive to physicians and other office‐based practitioners if a link could be made between interventions and these types of healthcare settings.…”

“…Finally, lack of time was overwhelmingly the most common barrier reported by physicians to assessing family caregiver needs and risks in the study by Riffin and colleagues 10 . How can physicians make the most of their limited time with older patients and families yet provide tailored education, support, and referrals?…”

“…[17][18] Compilations of caregiver assessment tools have been developed and disseminated for use by health care practitioners, 19 but evidence is lacking regarding the degree to which such tools have been adopted in outpatient medical care encounters with older adults. Riffin and colleagues point out that Medicare reimbursement policies have facilitated the potential use of caregiver assessment tools, 10 but in order for these opportunities to be realized mechanisms must be put in place to routinely embed and capture caregiver assessment tools and data into electronic medical records in outpatient settings. Two key elements needed to achieve this potential are physician champions within health care systems and willingness of information technology decision Accepted Article makers within care settings to configure electronic health record systems to easily capture, store, and report back to physicians the results of caregiver assessment data.…”

“…Finally, lack of time was overwhelmingly the most common barrier reported by physicians to assessing family caregiver needs and risks in the study by Riffin and colleagues. 10 How can physicians make the most of their limited time with older patients and families, yet provide tailored education, support, and referrals? Caregivers vary widely in their need for support, depending on circumstances at any point in time, and their needs change over time based on new sources of stress and need for skills-based training.…”

“…In this issue of the Journal , Riffin and colleagues report results from a recent national survey of primary care physicians, the majority of whom were in private practice, suggesting that positive strides have been made but that considerable improvement is needed in how physicians support family caregivers of their older patients 10 . Although the response rate in this study was disappointingly low (22%), and the sample size in this study was quite modest (62 geriatricians and 44 general internists), the authors made the most of the data they gathered and cast their findings and recommendations nicely within current practice and policy trends regarding ongoing barriers and facilitators to assessing the needs of family members of older patients.…”