Janani Thillainadesan1,2,3, Jesse Jansen4, Jacqui Close5, Sarah Hilmer6, Vasi Naganathan7,8,9. 1. Department of Geriatric Medicine, Concord Hospital, Sydney, Australia. Janani.Thillainadesan@health.nsw.gov.au. 2. Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Janani.Thillainadesan@health.nsw.gov.au. 3. Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Sydney, Australia. Janani.Thillainadesan@health.nsw.gov.au. 4. Centre Wiser Healthcare, and Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 5. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. 6. Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, Sydney, Australia. 7. Department of Geriatric Medicine, Concord Hospital, Sydney, Australia. 8. Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 9. Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Sydney, Australia.
Abstract
BACKGROUND: Perioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians' perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services. METHODS: A qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach. RESULTS: Geriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development. CONCLUSIONS: Geriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.
BACKGROUND: Perioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians' perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services. METHODS: A qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach. RESULTS: Geriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development. CONCLUSIONS: Geriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.
Entities:
Keywords:
Geriatricians; Health services for the aged; Perioperative care; Qualitative research
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