Community Physician Education in Geriatrics: Applying the Assessing Care of Vulnerable Elders Model with a Multisite Primary Care Group

Abstract

Providing practicing physicians with effective education that leads to better patient outcomes remains challenging. In 2003, the University of Cincinnati College of Medicine developed a comprehensive program to enhance practicing physician geriatric medicine education based on the Assessing the Care of Vulnerable Elders model. The program was implemented with a large, multisite primary care group based in the greater Cincinnati area and was designed to increase physicians' clinical skills and assist them in implementing new office and system strategies that could improve the quality of care for their older patients. Four topic areas were chosen: medication management, falls and mobility, urinary incontinence, and dementia. A multifaceted physician education program was developed for each topic area, with lunch-time, in-office, geriatrician-led presentations as the primary intervention. Over a 4-year period (2004-2007), more than 60 physicians in 16 primary care practices attended 107 teaching sessions. The value of the presentation content, quality of the presentations, and perception of meeting the primary care physicians' (PCPs') educational needs were each rated at 3.8 or above (4=excellent). Between 80% and 92% of the PCPs planned to make a change in their practice behavior as a result of the training, but only two offices initiated formal quality improvement projects. During the teaching sessions, the PCPs were provided with screening tools to identify "at risk" patients, assessment chart templates, and community resource and patient education materials. The application of a modified version of the ACOVE model to reach a large group of primary care physicians is possible and may be one strategy to improve the assessment and management of geriatric syndromes.

Perception of primary care physicians on the impact of comprehensive geriatric assessment: what is the next step?

“…Second, the development of an adherence program that not only follows up with the PCPs and patients after the initial consultation but also help PCPs understand the potential clinical value and cost-effectiveness of outpatient CGA may also increase adherence, since both have been shown to promote PCPs’ adherence. Lastly, improving continuing geriatric education for PCPs, both through traditional models and case-based learning from specific consultations, would improve PCPs ability to directly care for their older patients, facilitate adherence and implementation of CGA recommendations, and promote collaborative teamwork which is the foundation of geriatric care [ 13 – 15 ]. These changes will be neither quick nor easy to implement.…”

Improving Primary Care Fall Risk Management: Adoption of Practice Changes After a Geriatric Mini-Fellowship

“…In the Warshaw study, despite 107 1-hour sessions being taught to over 60 physicians in 16 practices over 4 years, only 2 practices ultimately initiated any practice change projects. 32 We believe that only curricula that embed practice change skills and opportunities, at a significant enough dose, can actually impact practice change in a sustainable manner. Knowledge and skill acquisition among individual providers does not take place to a sufficient degree in the current health care arena, which is focused on productivity and short visit times.…”

“…In terms of the educational intervention itself, most studies of geriatric education interventions have measured changes in knowledge, confidence, or self-efficacy as they relate to geriatric competence, [28][29][30] and do not measure practice change as an outcome outside of intent to change or self-reported practice change. 31,32 In general, practice change or longer-term health care-related outcomes have not been studied. Additionally, a range of dosages of educational interventions has been studied, from 1-hour lunchtime presentations 23,32 to half-day 29 or several half-day workshops, 28 up to 160 hours over 10 months 30 or 5 weekends over 6 months.…”

“…31,32 In general, practice change or longer-term health care-related outcomes have not been studied. Additionally, a range of dosages of educational interventions has been studied, from 1-hour lunchtime presentations 23,32 to half-day 29 or several half-day workshops, 28 up to 160 hours over 10 months 30 or 5 weekends over 6 months. 31 The duration of our entire intervention at 160 hours over 6 months would be considered on the upper end of dosing relative to these studies, with our Mobility week intervention comprising 32 hours during 1 week.…”

Frailty: A Common Pathway in Aging and Cancer

“…The second context includes a number of health domains, such as falls, incontinence, impair mobility or cognitive decline where age is a risk factor for impairment [44] and that should represent a special focus of care for older individuals [45]. In this construct, vulnerability is an attribute of aging that should be used to direct the care as well as to assess the quality of care of older individuals [46].…”