Outpatient Geriatric Care Research Articles

Outpatient geriatric health care in the German federal state of Mecklenburg-Western Pomerania: a population-based spatial analysis of claims data

BackgroundDue to unidentified geriatric needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to identify geriatric needs. Holistic and coordinated therapeutic approaches addressing those needs maintain the independence of elderly patients and avoid adverse effects. General practitioners are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the very rural Federal State of Mecklenburg-Western Pomerania in the Northeast of Germany and to identify regional disparities.MethodsGeographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran’s I analysis was carried out to identify clusters of utilization rates.ResultsOf all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified.ConclusionsThe widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs’ practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.

The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome.

To identify the usefulness of Four Square Step Test (FSST) in discriminating balance control in non-frail, pre-frail, and frail community-dwelling older adults. Cross-sectional study. Cross- sectional study conducted in specialized outpatient geriatric care settings. One hundred and fifty-six consecutive patients without severe cognitive impairment and who could walk were included. We classified participants as non-frail, pre-frail, and frail using the Fried frailty phenotype. FSST was assessed by measuring the time (seconds) participants took to step into each of the four quadrants formed by four sticks arranged on the floor (clockwise and counterclockwise as quickly as possible) without knocking the sticks. Of all participants, 36% were non-frail, 37% pre-frail, and 27% frail. Frail and pre-frail older adults took significantly more time to execute the FSST (23.1, 95% CI 18.8-27.4; p<0.001 and 17.9; 95% CI 14.3-21.5; p=0.003, respectively) compared to with non-frail (11.6, 95% CI 11.0-12.3). Frail and pre-frail older adults were not significantly different (p=0.058). Most participants who failed to perform the test were frail (n=15; 36%), followed by pre-frail (n=7; 12%) and non-frail (n=2; 3.5%). Our results showed that pre-frail and frail older adults had poorer performance in FSST when compared to non-frail older adults. It is important to use instruments that allow early identification, especially of pre-frail older adults, as they are still at the beginning of the frailty process when the control and reversal of adverse outcomes are promising. Failing the test could be a sign of mobility loss, particularly due to balance and cognitive problems. Clinical practitioners could use the test to compare individual's performance attending rehabilitation programs over different periods of time. FSST is a useful and safe measure of dynamic balance and discriminates frail and pre-frail from non-frail older adults. Further diagnostic accuracy studies should be conducted to determine FSST predictive capacity.

Using Telemedicine for Outpatient Geriatric Care During the Novel Coronavirus Outbreak: Experience from the First 15 Patients

Using Telemedicine for Outpatient Geriatric Care During the Novel Coronavirus Outbreak: Experience from the First 15 Patients

Outpatient care for the old and very old

Outpatient treatment of elderly patients is the responsibility of the family doctor. In addition to general practitioner care, there are some regionally different models that are currently not established and evaluated in Germany. The investigation presented here aims to contribute to the profiling of outpatient geriatric care in the future. A full survey on the attitude and acceptance of general practitioners towards outpatient geriatrics and a geriatric focus practice was carried out. At the same time, referral and advisory events were systematically recorded and compared. A geriatric focus practice can complement primary care. It is well accepted by many family doctors if there is a transparent exchange, pilot function and basic family doctor activities remain with the family doctor and he is relieved of the burden on complex patients.

The effects of interdisciplinary outpatient geriatrics on the use, costs and quality of health services in the fee-for-service environment

To evaluate the effect of interdisciplinary outpatient geriatrics on the use, cost, and quality of health services in a fee-for-service (FFS) environment of two networks of primary care clinics operated by a not-for-profit provider organization in Dallas County, Texas. The Senior Health Network (SHN) provides interdisciplinary primary care to patients aged 55 years or older; the Health Texas Provider Network (HTPN) provides "usual" primary care to patients of all ages. We conducted a two-year retrospective cohort study of 13,098 fee-for-service Medicare beneficiaries who had 2+ visits to one of the networks in 2000. In the SHN, interdisciplinary teams supplemented primary care with social services, specialized clinics, and health education. We compared the use, cost and quality of health services, as reflected by paid Medicare claims, provided to eligible patients in the SHN vs the HTPN. Medicare payments for hospital, skilled nursing facility, and home health care services were lower for SHN patients than HTPN patients (-32.7%, -19.8%, and -23.8%, respectively, p<or=0.05). SHN patients had a lower likelihood of admission to hospitals for treatment of five "ambulatory care sensitive conditions" (aOR 0.69, 95% CI 0.58- 0.81), and they were less likely to receive several preventive services. Total Medicare payments for the two cohorts did not differ significantly. Interdisciplinary outpatient geriatric care in a FFS setting has the potential to avert hospital admissions for ambulatory care sensitive conditions and to reduce Medicare payments for hospital, skilled nursing facility, and home health care services.

Outpatient geriatric care improved satisfaction but not health in frail elderly men

Source Citation Engelhardt JB, Toseland RW, O'Donnell JC, et al. The effectiveness and efficiency of outpatient geriatric evaluation and management. J Am Geriatr Soc. 1996 Jul; 44:847-56.

Working Group Recommendations: Methods for Geriatric Evaluation and Management Research

Methodological issues relating to multi-site studies of inpatient geriatric evaluation and management units were the focus of this working group's deliberations. The group favored a randomized clinical trial in which the inpatient geriatric evaluation and management unit was coupled with outpatient geriatric care. Inclusion of a broad spectrum of patients stratified according to risk for poor hospital outcomes was proposed in order to obtain information on the types of patients that would be most likely to benefit. The need for a detailed definition and description of care in the unit and of "usual care" was emphasized. Serious concerns were raised about including both VA medical centers and private hospitals in the same trial due to differences in the implementation of such a program. Furthermore, fears of contamination of the control group suggested that hospitals could be randomized either to provide usual care or have a GEM unit. However, this strategy would necessitate that hospitals that have already developed inpatient GEM units would be excluded from the trial and could be costly because of the number of hospitals that would be required.