Clinical questions raised by providers in the care of older adults: a prospective observational study

Abstract

ObjectiveTo characterise clinical questions raised by providers in the care of complex older adults in order to guide the design of interventions that can help providers answer these questions.Materials and methodsTo elicit clinical questions, we observed and audio recorded outpatient visits at three healthcare organisations. At the end of each appointment, providers were asked to identify clinical questions raised in the visit. Providers rated their questions based on their urgency, importance to the patient's care and difficulty in finding a useful answer to. Transcripts of the audio recordings were analysed to identify ageing-specific factors that may have contributed to the nature of the questions.ResultsWe observed 36 patient visits with 10 providers at the three study sites. Providers raised 70 clinical questions (median of 2 clinical questions per patient seen; range 0–12), pursued 50 (71%) and successfully answered 34 (68%) of the questions they pursued. Overall, 36 (51%) of providers’ questions were not answered. Over one-third of the questions were about treatment alternatives and adverse effects. All but two clinical questions were motivated either directly or indirectly by issues related to ageing, such as the normal physiological changes of ageing and diseases with higher prevalence in the elderly.ConclusionsThe frequency of clinical questions was higher than in previous studies conducted in general primary care patient populations. Clinical questions were predominantly influenced by ageing-related issues. We propose a series of recommendations that may be used to guide the design of solutions to help providers answer their clinical questions in the care of older adults.

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

“…About 50% of the total sample of DIIs were culled solely from instant message archives and yet were not documented in the pharmacist encounter log, suggesting under-documentation. Nevertheless, this study's sample of questions was roughly four times larger than the prior studies assessing general or drug-specific information needs of PCOA [1,9]. While larger samples are desirable, we believe that our sample size provides meaningful results given the number of pharmacists (23) and prescribers (102) involved in this study.…”

“…When interviewed in qualitative studies, physicians and other healthcare practitioners have acknowledged that although medication management for older adults is complex and challenging, it can be optimized through interdisciplinary collaboration with pharmacists [26][27][28]. Moreover, other studies of this subject matter similarly suggested that the majority of drug information needs of PCOAs involve adverse drug reactions and drug selection considerations [1,9]. Our study's findings shed much-needed light on the drug information needs of PCOAs and, moreover, the collaboration that transpires between prescribers and pharmacists in the PACE setting.…”

“…It is estimated that prescribers caring for older adults (PCOAs) raise about two clinical questions for every patient seen during an encounter, and drug information typically accounts for the largest proportion of these questions [1]. Despite considering the majority of their questions to be "important" for patient care, PCOAs have indicated that they do not find or pursue answers to about 50% of their questions [1]. Writing prescriptions in spite of unmet drug information needs can lead to poor care quality and adverse drug events, both of which disproportionately affect older adults [1][2][3][4][5][6].…”

“…Despite considering the majority of their questions to be "important" for patient care, PCOAs have indicated that they do not find or pursue answers to about 50% of their questions [1]. Writing prescriptions in spite of unmet drug information needs can lead to poor care quality and adverse drug events, both of which disproportionately affect older adults [1][2][3][4][5][6]. As drug information experts, pharmacists can help solve this potential problem.…”

Exploring patient information needs in type 2 diabetes: A cross sectional study of questions

“…Clinical information needs have been extensively studied by collecting questions from physicians and analyzing them [ 24 – 44 ]. For patients and the general population, the situation is very different.…”