Samantha L Solimeo1,2,3,4, Melissa J A Steffen1,2,3, Ellen E Gardner4,5, Omonyêlé Adjognon6, Marlena H Shin6, Jennifer Moye6,7,8, Jennifer L Sullivan6,9. 1. Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA. 2. Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa, USA. 3. Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Washington, DC, USA. 4. University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 5. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. 6. Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA. 7. New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA. 8. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. 9. Boston University, Boston, Massachusetts, USA.
Abstract
OBJECTIVES: To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN: Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING: GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS: GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS: Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS: Using the PACT Resources Framework, we identified facility-, clinic-, and team-level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION: Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource-trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real-time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVES: To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN: Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING: GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS: GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS: Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS: Using the PACT Resources Framework, we identified facility-, clinic-, and team-level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION: Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource-trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real-time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
Entities:
Keywords:
patient-centered medical home; primary care; qualitative research; veterans
Authors: Omonyêlé L Adjognon; Marlena H Shin; Melissa J A Steffen; Jennifer Moye; Samantha Solimeo; Jennifer L Sullivan Journal: Health Serv Res Date: 2021-08-27 Impact factor: 3.734
Authors: Chelsea E Hawley; Nicole Genovese; Montgomery T Owsiany; Laura K Triantafylidis; Lauren R Moo; Amy M Linsky; Jennifer L Sullivan; Julie M Paik Journal: J Am Geriatr Soc Date: 2020-10-04 Impact factor: 7.538