‘We can do only what we have the means for’ general practitioners’ views of primary care for older people with complex health problems

Abstract

BackgroundDue to demographic change, general practitioners (GPs) are increasingly required to care for older people with complex health problems. Little is known about the subjective appraisals of GPs concerning the demanded changes. Our objective is to explore how general practitioners view their professional mandates and capacities to provide comprehensive care for older people with complex health problems. Do geriatric training or experience influence viewpoints? Can barriers for the implementation of changes in primary care for older people with complex health problems be detected?MethodsPreceding a controlled intervention study on case management for older patients in the primary care setting (OMAHA II), this qualitative study included 10 GPs with differing degrees of geriatric qualification. Semi structured interviews were conducted and audio-taped. Full interview transcripts were analyzed starting with open coding on a case basis and case descriptions. The emerging thematic structure was enriched with comparative dimensions through reiterated inter-case comparison and developed into a multidimensional typology of views.ResultsBased on the themes emerging from the data and their presentation by the interviewed general practitioners we could identify three different types of views on primary care for older people with complex health problems: ‘maneuvering along competence limits’, ‘Herculean task’, and ‘cooperation and networking’. The types of views differ in regard to role-perception, perception of their own professional domain, and action patterns in regard to cooperation. One type shows strong correspondence with a geriatrician. Across all groups, there is a shared concern with the availability of sufficient resources to meet the challenges of primary care for older people with complex health problems.ConclusionsLimited financial resources, lack of cooperational networks, and attitudes appear to be barriers to assuring better primary care for older people with complex health problems. To overcome these barriers, geriatric training is likely to have a positive impact but needs to be supplemented by regulations regarding reimbursement. Most of all, general practitioners’ care for older people with complex health problems needs a conceptual framework that provides guidance regarding their specific role and contribution and assisting networks. For example, it is essential that general practice guidelines become more explicit with respect to managing older people with complex health problems.

Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals

“…The relatively good attainability of goals in the physical cluster is possibly due to the central role of the general practitioner in the Elderly Care Teams in this study. As they feel most able to solve problems in the physical domain compared to other domains [38]. Another explanation might be the persistent or stubborn character of pain [39][40][41] and psychological complaints [42] in contrast to physical complaints.…”

Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives

“…As the population ages, increasing numbers of OP are “ageing in place.” However, ageing in general is often accompanied with increasing dependency, health decline and ultimately increased healthcare utilisation (Boyd et al., ; Vasunilashorn, Steinman, Liebig, & Pynoos, ). As a consequence, primary health care of older adults is becoming more complex and burdensome requiring a disproportionate amount of primary healthcare team resources (Herzog et al., ). New models of care are necessary to enable primary healthcare teams to meet the needs of the expanding ageing population in the coming years (Frank & Wilson, ).…”

“…Existing models of health care frequently do not adequately provide the coordinated and comprehensive care required as people age and a new model is needed that encompasses all aspects of wellness including medical, emotional, functional and financial areas of need (Ham, ). Worldwide, general practitioners (GPs) are treating an increasing number of OP (Frank & Wilson, ; Royal College of General Practitioners, ; Zwijsen, Nieuwenhuizen, Maarsingh, Depla, & Hertogh, ), with the majority of these older patients having complex health needs (Herzog, Gaertner, Scheidt‐Nave, & Holzhausen, ). The importance that primary health care plays in providing comprehensive care for OP with multimorbidity and increasing frailty is well recognised (Oliver, ).…”

“…In addition, multimorbidity results in complex syndromes requiring a systematic assessment and multipronged approach to care. Therefore, a key aspect to successful care coordination for highly complex OP living in the community is expert knowledge in multiple chronic conditions as well as the fundamentals of older adult care (Herzog et al., ).…”

Older persons are more frail after an emergency care visit to the out-of-hours General Practitioner Cooperative in the Netherlands: a cross sectional descriptive TOPICS-MDS study

“…The preference of older persons to what extend and how to be involved in shared decision making in primary healthcare varies(43), whereas GP characteristics, communication skills, GP consultation duration, and continuity of (emergency) healthcare were described as important factors in the enhancement of shared decision making(44,45). GPs themselves showed different perspectives on their role in the management of complex health problems of older persons in primary care, varying from 'maneuvering along competence limits', 'Herculean task', and 'cooperation and networking'(46).…”