A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide "Geriatric" Care
OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists. DESIGN: Observational study. SETTING: Three primary care clinics of an academic medical center. PARTICIPANTS: Random sample of 140 adu...
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| Veröffentlicht in: | Journal of the American Geriatrics Society 2008-10, Vol.56 (10), p.1807-1811 |
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| container_title | Journal of the American Geriatrics Society |
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| creator | Phelan, Elizabeth A. Genshaft, Scott Williams, Barbara LoGerfo, James P. Wagner, Edward H. |
| description | OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists.
DESIGN: Observational study.
SETTING: Three primary care clinics of an academic medical center.
PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.
MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was ed.
RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P |
| doi_str_mv | 10.1111/j.1532-5415.2008.01942.x |
| format | Article |
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DESIGN: Observational study.
SETTING: Three primary care clinics of an academic medical center.
PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.
MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was ed.
RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57–8.94).
CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2008.01942.x</identifier><identifier>PMID: 19054199</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Academic Medical Centers ; Aged ; Aged, 80 and over ; Ambulatory Care Facilities - utilization ; ambulatory care/patterns ; Biological and medical sciences ; Comorbidity ; Comparative studies ; Drug Therapy ; Family physicians ; fee-for-service plans/standards ; Fellowships and Scholarships ; General aspects ; Geriatric Assessment ; Geriatrics ; Geriatrics - education ; Geriatrics - statistics & numerical data ; Health care delivery ; Health participants ; Health Services for the Aged ; health services for the aged/standards ; health services research ; Humans ; Medical sciences ; Miscellaneous ; Older people ; Outpatient care facilities ; physicians ; Physicians, Family - utilization ; practice patterns ; Primary Health Care ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of Health Care ; Specialists ; United States</subject><ispartof>Journal of the American Geriatrics Society, 2008-10, Vol.56 (10), p.1807-1811</ispartof><rights>2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society</rights><rights>2009 INIST-CNRS</rights><rights>Journal compilation 2008 The American Geriatrics Society/Blackwell Publishing</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5122-e4d2e513425784ad2bfc266a5031bafc67ff44d153a19f0cd0b966730a41a73b3</citedby><cites>FETCH-LOGICAL-c5122-e4d2e513425784ad2bfc266a5031bafc67ff44d153a19f0cd0b966730a41a73b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2008.01942.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2008.01942.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,1411,23909,23910,25118,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21127654$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19054199$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phelan, Elizabeth A.</creatorcontrib><creatorcontrib>Genshaft, Scott</creatorcontrib><creatorcontrib>Williams, Barbara</creatorcontrib><creatorcontrib>LoGerfo, James P.</creatorcontrib><creatorcontrib>Wagner, Edward H.</creatorcontrib><title>A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide "Geriatric" Care</title><title>Journal of the American Geriatrics Society</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists.
DESIGN: Observational study.
SETTING: Three primary care clinics of an academic medical center.
PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.
MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was ed.
RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57–8.94).
CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care Facilities - utilization</subject><subject>ambulatory care/patterns</subject><subject>Biological and medical sciences</subject><subject>Comorbidity</subject><subject>Comparative studies</subject><subject>Drug Therapy</subject><subject>Family physicians</subject><subject>fee-for-service plans/standards</subject><subject>Fellowships and Scholarships</subject><subject>General aspects</subject><subject>Geriatric Assessment</subject><subject>Geriatrics</subject><subject>Geriatrics - education</subject><subject>Geriatrics - statistics & numerical data</subject><subject>Health care delivery</subject><subject>Health participants</subject><subject>Health Services for the Aged</subject><subject>health services for the aged/standards</subject><subject>health services research</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Older people</subject><subject>Outpatient care facilities</subject><subject>physicians</subject><subject>Physicians, Family - utilization</subject><subject>practice patterns</subject><subject>Primary Health Care</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quality of Health Care</subject><subject>Specialists</subject><subject>United States</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV2LEzEUhoMobq3-BQkF927GfE_mwoul7naVZV1wRRAknMlkMHU6qUlru__ejC0V9srkIiF53sPJE4QwJSXN4-2ypJKzQgoqS0aILgmtBSv3T9DkdPEUTQghrNCKijP0IqUlIZQRrZ-jM1qTjNT1BH2_wPOwWkP0KQw4dPg67PDCDS5C79MmYRhafOX6PuzSD78u7iP4wbUZiR420VsPQ8J3Mfz2rcOz0_EMzyG6l-hZB31yr47rFH25uryfXxc3nxYf5hc3hZWUscKJljlJuWCy0gJa1nSWKQWScNpAZ1XVdUK0-WlA647YljS1UhUnIChUvOFTdH6ou47h19aljVn5ZHPXMLiwTUbVWvFxTtHsEbgM2zjk3gyjhGsmhciQPkA2hpSi68w6-hXEB0OJGf2bpRk1m1GzGf2bv_7NPkdfH-tvm5Vr_wWPwjPw5ghAstB3EQbr04ljlLJKybGHdwdu53v38N8NmI-Lz-Mu54tDPn-i25_yEH-aLK6S5uvtwtwx9l4rJs03_gdzM63v</recordid><startdate>200810</startdate><enddate>200810</enddate><creator>Phelan, Elizabeth A.</creator><creator>Genshaft, Scott</creator><creator>Williams, Barbara</creator><creator>LoGerfo, James P.</creator><creator>Wagner, Edward H.</creator><general>Blackwell Publishing Inc</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200810</creationdate><title>A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide "Geriatric" Care</title><author>Phelan, Elizabeth A. ; Genshaft, Scott ; Williams, Barbara ; LoGerfo, James P. ; Wagner, Edward H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5122-e4d2e513425784ad2bfc266a5031bafc67ff44d153a19f0cd0b966730a41a73b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care Facilities - utilization</topic><topic>ambulatory care/patterns</topic><topic>Biological and medical sciences</topic><topic>Comorbidity</topic><topic>Comparative studies</topic><topic>Drug Therapy</topic><topic>Family physicians</topic><topic>fee-for-service plans/standards</topic><topic>Fellowships and Scholarships</topic><topic>General aspects</topic><topic>Geriatric Assessment</topic><topic>Geriatrics</topic><topic>Geriatrics - education</topic><topic>Geriatrics - statistics & numerical data</topic><topic>Health care delivery</topic><topic>Health participants</topic><topic>Health Services for the Aged</topic><topic>health services for the aged/standards</topic><topic>health services research</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Older people</topic><topic>Outpatient care facilities</topic><topic>physicians</topic><topic>Physicians, Family - utilization</topic><topic>practice patterns</topic><topic>Primary Health Care</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Quality of Health Care</topic><topic>Specialists</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phelan, Elizabeth A.</creatorcontrib><creatorcontrib>Genshaft, Scott</creatorcontrib><creatorcontrib>Williams, Barbara</creatorcontrib><creatorcontrib>LoGerfo, James P.</creatorcontrib><creatorcontrib>Wagner, Edward H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phelan, Elizabeth A.</au><au>Genshaft, Scott</au><au>Williams, Barbara</au><au>LoGerfo, James P.</au><au>Wagner, Edward H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide "Geriatric" Care</atitle><jtitle>Journal of the American Geriatrics Society</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2008-10</date><risdate>2008</risdate><volume>56</volume><issue>10</issue><spage>1807</spage><epage>1811</epage><pages>1807-1811</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists.
DESIGN: Observational study.
SETTING: Three primary care clinics of an academic medical center.
PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.
MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was ed.
RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57–8.94).
CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>19054199</pmid><doi>10.1111/j.1532-5415.2008.01942.x</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American Geriatrics Society, 2008-10, Vol.56 (10), p.1807-1811 |
| issn | 0002-8614 1532-5415 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Academic Medical Centers Aged Aged, 80 and over Ambulatory Care Facilities - utilization ambulatory care/patterns Biological and medical sciences Comorbidity Comparative studies Drug Therapy Family physicians fee-for-service plans/standards Fellowships and Scholarships General aspects Geriatric Assessment Geriatrics Geriatrics - education Geriatrics - statistics & numerical data Health care delivery Health participants Health Services for the Aged health services for the aged/standards health services research Humans Medical sciences Miscellaneous Older people Outpatient care facilities physicians Physicians, Family - utilization practice patterns Primary Health Care Public health. Hygiene Public health. Hygiene-occupational medicine Quality of Health Care Specialists United States |
| title | A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide "Geriatric" Care |
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