Geriatric Primary Care Research Articles

Characteristics and Patterns of Marijuana Use in Community-Dwelling Older Adults.

To understand patterns of marijuana use in community-dwelling older adults in Colorado. Anonymous survey. Two academic geriatric primary care clinics. English-speaking individuals. We assessed self-reported characteristics and patterns of marijuana use and effect on targeted symptoms. Survey analysis focused on current users, defined as individuals who had used marijuana in the past 3 years. Three hundred forty-five individuals completed the survey (55% response rate); 113 (32%) had used marijuana in the past, of whom 55 (16%) had used since legalization. More than half of current users were aged 75 and older, and one-quarter were aged 85 and older. Most current users were white women. Of current users, 44% used marijuana products at least weekly for common conditions including chronic pain, depression, anxiety, and insomnia, and most found marijuana helpful for these conditions. Most respondents reported obtaining marijuana recreationally (67%) without a prescription. Nine respondents reported negative side effects attributable to marijuana use. To our knowledge, this is the first study to characterize marijuana use of older adults in a state in which it is legal for medical and recreational use. Marijuana was used for several common geriatric conditions, and respondents reported few side effects. The small number of survey respondents, the lack of generalizability in states where marijuana sales are illegal, and participation bias were the main study limitations. Further research is needed to better understand useful or harmful effects in this population. J Am Geriatr Soc 66:2167-2171, 2018.

Implementation of a Workflow Initiative for Integrating Transitional Care Management Codes in a Geriatric Primary Care Practice.

We implemented a transitional care management service led by a nurse care manager. An interdisciplinary team developed a workflow using a Plan-Do-Study-Act cycle for contacting patients. Of the 146 (97.9%) eligible patients, 143 (97.9%) had a phone call within 48 hours. There were 84 of 120 (70.0%) and 117 of 120 (97.5%) attendance rates of those attending visits within 7 and 14 days. A care manager-led workflow was successfully and easily implemented within a primary care practice.

Prevalence of depressed mood and loss of interest among community-dwelling older people: Large-scale questionnaire survey and visiting intervention.

Late-life depression is identified less often by general practitioners than depression in younger adults, but failure to have late-life depression recognized in a primary care setting can have fatal consequences. The aim of the present study was to examine the prevalence of depressed mood and loss of interest, and identify associated factors among community-dwelling older adults in a large-scale study. A questionnaire was mailed to all residents (n = 132 005) aged ≥65 years in one Tokyo district. The questionnaire asked about depressed mood and loss of interest. It also included items measuring sociodemographic variables, physical health-related variables, psychological variables, socioeconomic variables, attitude to the community and the Dementia Assessment Sheet for Community-based Integrated Care System - 21 items. In total, 19.5% of community-dwelling older people had experienced a depressed mood or loss of interest during the past month. This group also showed increased frailty and a negative attitude towards the community, and were less likely to be economically disadvantaged (although more likely to have had a childhood economic disadvantage). The multivariate analysis showed that increased frailty had the strongest relationship with depressed mood. Survey respondents who had either of these conditions were more likely to receive support from the community-based integrated support center. The present study showed a high prevalence of depressed mood and loss of interest among older people. Frailty was a significant factor, suggesting that collaboration is essential between primary care geriatrics and geriatric psychiatry. Geriatr Gerontol Int 2018; 18: 1567-1572.

Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs

To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability. The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research. Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time equivalent psychiatrists and 0.44 full-time equivalent psychologists per team (suggested panel = 800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial χ2 = 8.87, cognitive χ2 = 8.68, and depressive χ2 = 11.85 conditions in their panel than those without behavioral health providers. GeriPACT mental health integration is less than 50%. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and need further study.

Development and economic evaluation of a pharmacist-provided chronic care management service in an ambulatory care geriatrics clinic.

The implementation and delivery of a pharmacist-led chronic care management (CCM) service in a geriatric primary care clinic are described. A CCM service was provided March 1 through December 31, 2016, at the University of Colorado Hospital Seniors Clinic ("Seniors Clinic"). The electronic health record (EHR) team for the University of Colorado Health system developed a patient registry through EPIC Healthy Planet (Epic Systems Corp., Verona, WI) to identify patients at the Seniors Clinic eligible for CCM services. The EHR team constructed a note type and documentation template within the EHR to ensure documentation of all necessary components for billing and to allow individual clinical staff to document the time spent providing CCM care. Overall, 36 elderly patients enrolled in the pharmacist-provided CCM service over the 10 months. Clinical pharmacists spent a total of 156-849 minutes per month providing CCM services, with a mean outreach time of 45.4 minutes per patient. The clinical pharmacists submitted 95 claims, and all but 5 were paid. The total amount reimbursed from the health plans during the 10 months was $2,775.02. Medicare patients were successfully enrolled in a CCM service in a geriatrics primary care clinic led by clinical pharmacists and medical providers. The CCM services were more time-consuming than the allotted 20 minutes per patient per month with the CCM Current Procedural Terminology code used during this study.

Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review.

Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD ( P = .038). The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.

Patient-Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial.

Establishing priorities for discussion during time-limited primary care visits is challenging in the care of patients with cognitive impairment. These patients commonly attend primary care visits with a family companion. To examine whether a patient-family agenda setting intervention improves primary care visit communication for patients with cognitive impairment DESIGN: Two-group pilot randomized controlled study PARTICIPANTS: Patients aged 65 + with cognitive impairment and family companions (n = 93 dyads) and clinicians (n = 14) from two general and one geriatrics primary care clinic INTERVENTION: A self-administered paper-pencil checklist to clarify the role of the companion and establish a shared visit agenda MEASUREMENTS: Patient-centered communication (primary); verbal activity, information disclosure including discussion of memory, and visit duration (secondary), from audio recordings of visit discussion RESULTS: Dyads were randomized to usual care (n = 44) or intervention (n = 49). Intervention participants endorsed an active communication role for companions to help patients understand what the clinician says or means (90% of dyads), remind patients to ask questions or ask clinicians questions directly (84% of dyads), or listen and take notes (82% of dyads). Intervention dyads identified 4.4 health issues for the agenda on average: patients more often identified memory (59.2 versus 38.8%; p = 0.012) and mood (42.9 versus 24.5%; p = 0.013) whereas companions more often identified safety (36.7 versus 18.4%; p = 0.039) and personality/behavior change (32.7 versus 16.3%; p = 0.011). Communication was significantly more patient-centered in intervention than in control visits at general clinics (p < 0.001) and in pooled analyses (ratio of 0.86 versus 0.68; p = 0.046). At general clinics, intervention (versus control) dyads contributed more lifestyle and psychosocial talk (p < 0.001) and less biomedical talk (p < 0.001) and companions were more verbally active (p < 0.005). No intervention effects were found at the geriatrics clinic. No effect on memory discussions or visit duration was observed. Patient-family agenda setting may improve primary care visit communication for patients with cognitive impairment. ClinicalTrials.gov : NCT02986958.

Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program

This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016–May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care.

The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

Psychometric Evaluation of the Symptoms of Dementia Screener (SDS) in a Geriatric Primary Care Population

ABSTRACTObjectives: The Symptoms of Dementia Screener (SDS) is an 11-item scale developed to screen for cognitive impairment. We aim to evaluate the psychometric properties of the SDS for use in primary care.Methods: We analyzed data from 192 patients: 25 not impaired, 42 with mild cognitive impairment (MCI), and 125 with dementia. Cronbach’s reliability, convergent validity, and clinical utility were examined. The SDS was investigated at the item level using binary two-parameter model item response theory (IRT) techniques.Results: The SDS demonstrated good reliability (11 items; α = .74). We found negative correlations between SDS and the Mattis DRS-2 (r = −.523, p < .01). Receiver operating characteristic (ROC) curves demonstrated acceptable clinical utility for detecting MCI and dementia with sensitivities and specificities of 83% and 52% for MCI; 78.4% and 84% for dementia, and 91% and 52% for any impairment. IRT analyses revealed 10 out of 11 items were moderately to very highly related to underlying latent factors of impairment.Conclusions: The SDS demonstrates good psychometric properties and is useful for detecting cognitive impairment in primary care settings.Clinical Implications: The SDS is an effective screening tool that does not require special training for its use in primary care. A positive screen indicates a need for further cognitive testing.

Cardiovascular risk factors among geriatric Nigerians in a primary care clinic of a tertiary hospital in Southeastern Nigeria

Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. This study was aimed at determining the frequencies of CV risk factors among geriatric Nigerians in a primary care clinic of a tertiary hospital in Southeastern Nigeria. Patients and Methods: This was a cross-sectional study carried out on 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Geriatric Nigerians aged 60 years and above were screened for risk factors of CV disease. The data collected included sociodemographic variables and metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher-administered questionnaire. Results: The top five most common CV risk factors were physical inactivity (67.1%), inadequate fruit consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcoholic beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that the risk factors of CV disease exist among geriatric Nigerians in primary care, with five most frequent being physical inactivity, inadequate fruit consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary care in the study area.

Cardiovascular risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-Eastern Nigeria: Implications for primary care geriatric cardiovascular health advocacy

Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. Aim: This study was aimed at determining the frequencies of nonconstitutional CV risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-eastern Nigeria. Setting and Design: This was a cross-sectional study carried out on a sampled of 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria, between May 2012 and October 2012. Subjects and Methods: Geriatric Nigerians aged 60 years and above were screened for nonconstitutional risk factors of CV disease. The data collected included sociodemographic variables, metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher administered the questionnaire. Results: The top five most common CV risk factors were as follows: physical inactivity (67.1%), inadequate fruits consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcohol beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that risk factors of CV disease exist among geriatric Nigerians in primary care with five most frequent being physical inactivity, inadequate fruits consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary health care in the study area.

Implementation of group visits to improve outpatient oncology advance care planning.

11 Background: Oncology patients that participate in advance care planning (ACP) and complete advance directives (AD) are more likely to receive goal-concordant end of life care. The AD documentation rate within our academically-affiliated community outpatient oncology clinic is below national and institutional averages. A group medical visit effectively facilitated ACP in a geriatric primary care setting. This quality improvement project implemented a similar ACP conversation group (ACPCG) in an outpatient oncology setting. Methods: Adult patients in a community oncology clinic were contacted and invited to participate in ACPCG by a nurse practitioner who works in the clinic. Using a facilitation guide, the 2-session intervention included sharing past ACP experiences, identifying surrogate decision makers, starting conversations, and discussing surrogate flexibility. Recruitment, retention, and patient ACP outcomes were measured. Results: Seventy-six patients were successfully contacted and seventeen signed up (22% recruitment rate). Twelve patients participated in the first session, and five attended the second session (42% retention). Recruitment was time intensive, and several patients responded that ACP was not relevant to their situation. Six participants completed an AD prior to attending the first session (50%) but only one had an AD in their medical record. Two had surrogate decision makers documented prior to the intervention (16%). Participants reported the ACPCG as helpful in making the process less overwhelming. There was no increase in AD documentation rates within the medical record four weeks after the intervention, but the rate of surrogate documentation increased to seven (58%). Conclusions: Participants had higher than average rates of AD completion prior to the intervention but had not shared the document with their providers. While the ACPCG was well received by patients, implementation faced multiple challenges. More efficient recruitment methods and strategies to facilitate better patient understanding of ACP are needed.

Impact of the automated dose dispensing with medication review on geriatric primary care patients drug use in Finland: a nationwide cohort study with matched controls

Objective: In an automated dose dispensing (ADD) service, medicines are dispensed in unit-dose bags according to administration times. When the service is initiated, the patient’s medication list is reconciled and a prescription review is conducted. The service is expected to reduce drug use. The aim of this national controlled study was to investigate whether the ADD service with medication review reduces drug use among geriatric primary care patients.Design, setting and patients: This is a nationwide cohort study with matched controls. The study group consisted of all primary care patients ≥65 years enrolled in the ADD service in Finland during 2007 (n = 2073). Control patients (n = 2073) were matched by gender, age, area of patient’s residence and number of the prescription drugs reimbursed. The data on all prescription drugs reimbursed during the 1 year periods before and after the ADD service enrollment were extracted from the Finnish National Prescription Register. Drug use was calculated as defined daily doses (DDD) per day.Results: The studied 20 most used drugs covered 86% of all reimbursed drug use (in DDD) of the study group. The use of 11 out of these 20 active substances studied was reduced significantly (p < .001–.041) when the drug use was adjusted by the number of chronic diseases. Two of these drugs were hypnotics and six were cardiovascular system drugs.Conclusions: Drug use was decreased after initiation of the ADD service in primary care patients ≥65 years compared to matched controls in this 1 year cohort study. Further studies should be conducted in order to explore the causality, assess the ADD service’s impact on drug use quality and costs, as well as impact of accompanied prescription review on positive outcomes.

The Association Between Fear of Falling and Fall Prevention Interventions Offered by an Occupational Therapist in a Geriatric Primary Care Setting

Abstract Date Presented 4/1/2017 This study demonstrates that occupational therapy fall prevention interventions are beneficial for improving quality of care as part of a coordinated care team within a primary care setting and should further be examined in expanded populations, settings, and interventions. Primary Author and Speaker: Lydia Royeen Contributing Authors: Kieran J. Fogarty, Brenda Koverman

Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia

ABSTRACTObjectives: Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period.Methods: Qualitative directed content analysis of retrospective EMR data.Results: Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers.Conclusion: Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care.Clinical Implications: The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.

Comparing behavioral health models for reducing risky drinking among older male veterans

ABSTRACTBackground: Screening older veterans in Veterans Affairs Medical Center (VAMC) primary care clinics for risky drinking facilitates early identification and referral to treatment. Objective: This study compared two behavioral health models, integrated care (a standardized brief alcohol intervention co-located in primary care clinics) and enhanced referral care (referral to specialty mental health or substance abuse clinics), for reducing risky drinking among older male VAMC primary care patients. VAMC variation was also examined. Method: A secondary analysis of longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study, a multisite randomized controlled trial, was conducted with a sample of older male veterans (n = 438) who screened positive for risky drinking and were randomly assigned to integrated or enhanced referral care at five VAMCs. Results: Generalized estimating equations revealed no differences in either behavioral health model for reducing risky drinking at a 6-month follow-up (AOR: 1.46; 95% CI: 0.42–5.07). Older veterans seen at a VAMC providing geriatric primary care and geriatric evaluation and management teams had lower odds of risky drinking (AOR: 0.24; 95% CI: 0.07–0.81) than those seen at a VAMC without geriatric primary care services. Conclusions: Both integrated and enhanced referral care reduced risky drinking among older male veterans. However, VAMCs providing integrated behavioral health and geriatric specialty care may be more effective in reducing risky drinking than those without these services. Integrating behavioral health into geriatric primary care may be an effective public health approach for reducing risky drinking among older veterans.

Process evaluation of an integrated care pathway in geriatric rehabilitation for people with complex health problems

BackgroundAn integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations. A process evaluation was performed to assess the feasibility of this pathway.MethodsThe study design incorporated mixed methods. Feasibility was assessed thru if the pathway was implemented according to plan (fidelity and dose delivered), (b) if patients, informal caregivers and professionals were satisfied with the pathway (dose received) and (c) which barriers and facilitators influenced implementation (context). These components were derived from the theoretical framework of Saunders and colleagues. Data were collected using three structured face-to-face interviews with patients, self-administered questionnaires among informal caregivers, and group interviews with professionals. Furthermore, data were collected from the information transfer system in the hospital, patient files of the geriatric rehabilitation facility and minutes of evaluation meetings.ResultsIn total, 113 patients, 37 informal caregivers and 19 healthcare professionals participated in this process evaluation. The pathway was considered largely feasible as two components were fully implemented according to plan and two components were largely implemented according to plan. The timing and quality of medical discharge summaries were not sufficiently implemented according to plan and professionals indicated that the triage instrument needed refinement. Healthcare professionals were satisfied with the implementation of the pathway and they indicated that due to improved collaboration, the quality of care provision improved. Although patients and informal caregivers were also satisfied with the care provision in the pathway, they indicated that the care organisations involved should pay more attention towards providing information about their treatment.ConclusionsThis process evaluation showed that patients, informal caregivers and professionals are fairly satisfied with the care provision in the pathway and professionals reported that collaboration improved. Extra attention should be paid to the components in the pathway that were not implemented according to plan.Trial registrationISRCTN90000867 Registered 7 April 2016.

Treatment-Resistant Depression in the Elderly: Diagnostic and Treatment Approaches

Depression is a common illness in the geriatric primary care population. Risk factors including serious medical illness and functional disability, as well as neurodegeneration and cardiovascular risk factors, can make treatment particularly difficult in late-life depression. There is a paucity of well-validated evidence to guide the geriatric clinician’s diagnosis and management of treatment-resistant late-life depression (TRLLD). In this article, I provide clinical recommendations for the evaluation and diagnosis of late-life depression appropriate for the geriatric primary care provider. With an accurate diagnosis, the geriatric physician can better construct a treatment plan. I will review evidence-based treatment approaches for TRLLD including antidepressant medications, augmentation strategies, psychotherapy options, and neuromodulation techniques.

Assessment of Perceived Barriers to Herpes Zoster Vaccination among Geriatric Primary Care Providers.

The herpes zoster vaccine is recommended for use in adults 60 years of age and older to reduce the incidence and morbidity associated with infection. Its limited uptake has been attributed to logistical barriers, but uncertain efficacy and safety in subsets of this patient population could also be contributing. The purpose of this study was to evaluate the current vaccination practices, barriers to vaccination, knowledge of vaccination reimbursement and strategies to evaluate for insurance coverage among an urban, safety net, teaching hospital, geriatric primary care provider group through a survey administered via paper and online platforms. Survey participants (n = 10) reported lack of availability of the vaccine in their practice settings (6/10), with half of providers (5/10) referring patients to outside pharmacies or to other practice settings (2/10) for vaccine administration. Reimbursement issues and storage requirements were perceived as major barriers by 40% (4/10) of providers, whereas 80% (8/10) of providers reported that concerns about safety and effectiveness of the vaccine were not major barriers to vaccination. Logistical barriers, rather than concerns about safety and effectiveness of the vaccine, were reported as major barriers to vaccination by a significant portion of providers. Lack of availability and reimbursement problems for practice sites allow for gaps in care. Partnership with community and long-term care pharmacies could serve as a possible solution.