How do geriatricians practise comprehensive geriatric assessment in the outpatient setting: an analysis of geriatricians' letters and a comparison to the Medicare benefits schedule requirement.
frailty
geriatric assessment
geriatrician
outpatient
quality of life
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
10 Oct 2024
10 Oct 2024
Historique:
received:
21
05
2024
accepted:
11
09
2024
medline:
13
10
2024
pubmed:
13
10
2024
entrez:
10
10
2024
Statut:
aheadofprint
Résumé
Little is known about what components geriatricians routinely incorporate into outpatient comprehensive geriatric assessments (CGAs). This study explored what components of CGAs are routinely incorporated into geriatricians' letters and assessed their consistency with the Medicare Benefits Schedule (MBS) and a recently published survey of geriatricians. We completed a manual content analysis, supplemented by qualitative thematic analysis, of 34 letters from five geriatricians, collected as part of the GOAL Trial. While more than 80% of letters included each of the key clinical domains described in the Medicare Benefits Schedule and survey of geriatricians, only 62% included advanced care planning and 47% mentioned immunisations. Forty-seven percent of letters included goal setting. Few letters showed evidence of multidisciplinary working. Issues identified by the geriatrician centred around the themes of advance care planning, symptom identification and management, medical comorbidities, strategies to support quality of life and interventions to manage frailty. Patient concerns identified in the letters were cognition and mood, declining function, future planning and symptom management. Analysis of geriatricians' letters provides important and novel insights into usual CGA practice. The letters provide evidence of multidimensional assessments of physical, functional, social and psychological health, and most include use of standardised tools. However, less than 50% include evidence of goal setting or multidisciplinary working. The results allow consideration of how CGAs might be carried out in the outpatient setting, so that interventions focused on improving the quality and efficacy of this intervention can be implemented.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known about what components geriatricians routinely incorporate into outpatient comprehensive geriatric assessments (CGAs).
AIMS
OBJECTIVE
This study explored what components of CGAs are routinely incorporated into geriatricians' letters and assessed their consistency with the Medicare Benefits Schedule (MBS) and a recently published survey of geriatricians.
METHODS
METHODS
We completed a manual content analysis, supplemented by qualitative thematic analysis, of 34 letters from five geriatricians, collected as part of the GOAL Trial.
RESULTS
RESULTS
While more than 80% of letters included each of the key clinical domains described in the Medicare Benefits Schedule and survey of geriatricians, only 62% included advanced care planning and 47% mentioned immunisations. Forty-seven percent of letters included goal setting. Few letters showed evidence of multidisciplinary working. Issues identified by the geriatrician centred around the themes of advance care planning, symptom identification and management, medical comorbidities, strategies to support quality of life and interventions to manage frailty. Patient concerns identified in the letters were cognition and mood, declining function, future planning and symptom management.
CONCLUSIONS
CONCLUSIONS
Analysis of geriatricians' letters provides important and novel insights into usual CGA practice. The letters provide evidence of multidimensional assessments of physical, functional, social and psychological health, and most include use of standardised tools. However, less than 50% include evidence of goal setting or multidisciplinary working. The results allow consideration of how CGAs might be carried out in the outpatient setting, so that interventions focused on improving the quality and efficacy of this intervention can be implemented.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Australian Government Research Training Program Stipend Scholarship
Organisme : National Health and Medical Research Council
ID : APP1178519
Informations de copyright
© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.
Références
Conroy SP, Bardsley M, Smith P, Neuburger J, Keeble E, Arora S et al. Comprehensive Geriatric Assessment for Frail Older People in Acute Hospitals: The HoW‐CGA Mixed‐Methods Study. Health Services and Delivery Research, No. 7.15. Southampton: NIHR Journals Library; 2019. https://doi.org/10.3310/hsdr07150.
Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K et al. What is comprehensive geriatric assessment (CGA)? An umbrella review. Age Ageing 2018; 47: 149–155.
Fox ST, Janda M, Hubbard R. Understanding how comprehensive geriatric assessment works: the importance of varied methodological approaches. Aging Clin Exp Res 2023; 35: 417–423.
Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005; 71: 45–59.
Pilotto A, Cella A, Pilotto A, Daragjati J, Veronese N, Musacchio C et al. Three decades of comprehensive geriatric assessment: evidence coming from different healthcare settings and specific clinical conditions. J Am Med Dir Assoc 2017; 18: 192.e1–192.e11.
Australian Government Department of Health and Aged Care, Commonwealth of Australia. MBS online Medicare benefits schedule [cited 2022 Aug 17]. Available from URL: http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=141&qt=ItemID
Fox S, Reid N, Gordon EH, Janda M, Hubbard RE. What do geriatricians think about comprehensive geriatric assessment? A survey of Australian and New Zealand geriatricians. Australas J Ageing 2022; 42: 127–139.
Mansur H, Colugnati F, Grincenkov FRDS, Bastos M. Frailty and quality of life: a cross‐sectional study of Brazilian patients with pre‐dialysis chronic kidney disease. Health Qual Life Outcomes 2014; 12: 27.
Logan B, Viecelli AK, Johnson DW, Aquino EM, Bailey J, Comans TA et al. Study protocol for the GOAL trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient‐identified goals‐a cluster randomised controlled trial. Trials 2023; 24: 365.
Krippendorff K. Content Analysis: An Introduction to Its Methodology. Thousand Oaks, CA: Sage Publications; 2019. https://doi.org/10.4135/9781071878781.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101.
Lumivero. NVivo. 14 ed.; 2023 [cited 2023 Jul 17]. Available from URL: www.lumivero.com
Braun V, Clark V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol 2021; 18: 328–352.
Rietkerk W, de Jonge‐de Haan J, Slaets JPJ, Zuidema SU, Gerritsen DL. Increasing older adult involvement in geriatric assessment: a mixed‐methods process evaluation. J Aging Health 2021; 33: 482–492.
Smit E, Bouwstra H, Hertogh C, Wattel E, van der Wouden JC. Goal‐setting in geriatric rehabilitation: a systematic review and meta‐analysis. Clin Rehabil 2019; 33: 395–407.
Ellis G, Whitehead MA, Neill DO, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2011; 6: CD006211.
Garrard J, Cox N, Dodds R, Roberts H, Sayer A. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res 2020; 32: 197–205.
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2017; 9: CD006211.
Ris I, Schnepp W, Imhof R. An integrative review on family caregivers' involvement in care of home‐dwelling elderly. Health Soc Care Community 2019; 27: e111.
Nilsen E, Hollister B, Söderhamn U, Dale B. What matters to older adults? Exploring person‐centred care during and after transitions between hospital and home. J Clin Nurs 2021; 31: 569–581.
Tattersall MHN, Butow PN, Brown JE, Thompson JF. Improving doctors' letters. Med J Aust 2002; 177: 516–520.
Rayner H, Hickey M, Logan I, Mathers N, Rees P, Shah R. Writing outpatient letters to patients. BMJ 2020; 368: m24.
Rash AH, Sheldon R, Donald M, Eronmwon C, Kuriachan VP. Valued components of a consultant letter from referring physicians' perspective: a systematic literature synthesis. J Gen Intern Med 2018; 33: 948–954.
Mitchell G, Tieman J, Shelby‐James T. Multidisciplinary care planning and teamwork in primary care. Med J Aust 2008; 188(Suppl 8): S61–S64.
Mickan S. Evaluating the effectiveness of health care teams. Aust Health Rev 2005; 29: 211–217.
Ellis G, Sevdalis N. Understanding and improving multidisciplinary team working in geriatric medicine. Age Ageing 2019; 48: 498–505.
Services Australia, Australian Government. Chronic disease GP management plans and team care arrangements; 2024 [updated 2024 Jan 3; cited 2024 Feb 12]. Available from URL: https://www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements
Junius‐Walker U, Schleef T, Vogelsang U, Dierks M. How older patients prioritise their multiple health problems: a qualitative study. BMC Geriatr 2019; 19: 362.