Geriatric medicine might well be the other "blind spot" in UK primary care, given the fact that rotation through geriatric medicine in not yet the norm for doctors who wish to take up general practice as a career. In the context of the predicted increase in the number of elderly people in many Western countries (including the UK) "good care for frail older people should be part of mainstream clinical practice"(1). Accordingly, it is unconscionable that "achievement for 14 of 16 quality indicators suitable for vulnerable older people was lower for residents of care homes than for those living in the community..."(2). What is more, "Residents in care homes were more likely to be excluded by doctors from QOF (Quality and Outcomes Framework) targets(2). This sorry state of affairs is compounded by the fact that, in one study, "age, independent of comorbidity, presentation, and patients' wishes, directly influenced decision making about, [for example], angina investigation and treatment by half of the doctors in the primary care and secondary care sample"(3). Accordingly, what we need is a primary care healthcare workforce which is well grounded in the complexity and nuances of disease presentation and management in old age, and that this should amount to a recognition that medical practice in the developed countries is, in essence, a vital ingredient of mainstream clinical practice.
References
(1) Parker S., Conroy S
Poor inpatient care for older people
BMJ 2011;342:612
(2)Shah SM., Carey IM., Harris T., DeWilde S., Cook DG
Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system:retrospective study
BMJ 2011;342:587-
(3) Harries C., Forrest D., Harvey N., McClelland A., Bowling A
Which doctors are influenced by a patient's age? a multi-method study of angina treatment in general practice, cardiology and gerontology
Qual Saf Health care 2007;16:23-27
Rapid Response:
Re: Do we need GPs?
Geriatric medicine might well be the other "blind spot" in UK primary care, given the fact that rotation through geriatric medicine in not yet the norm for doctors who wish to take up general practice as a career. In the context of the predicted increase in the number of elderly people in many Western countries (including the UK) "good care for frail older people should be part of mainstream clinical practice"(1). Accordingly, it is unconscionable that "achievement for 14 of 16 quality indicators suitable for vulnerable older people was lower for residents of care homes than for those living in the community..."(2). What is more, "Residents in care homes were more likely to be excluded by doctors from QOF (Quality and Outcomes Framework) targets(2). This sorry state of affairs is compounded by the fact that, in one study, "age, independent of comorbidity, presentation, and patients' wishes, directly influenced decision making about, [for example], angina investigation and treatment by half of the doctors in the primary care and secondary care sample"(3). Accordingly, what we need is a primary care healthcare workforce which is well grounded in the complexity and nuances of disease presentation and management in old age, and that this should amount to a recognition that medical practice in the developed countries is, in essence, a vital ingredient of mainstream clinical practice.
References
(1) Parker S., Conroy S
Poor inpatient care for older people
BMJ 2011;342:612
(2)Shah SM., Carey IM., Harris T., DeWilde S., Cook DG
Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system:retrospective study
BMJ 2011;342:587-
(3) Harries C., Forrest D., Harvey N., McClelland A., Bowling A
Which doctors are influenced by a patient's age? a multi-method study of angina treatment in general practice, cardiology and gerontology
Qual Saf Health care 2007;16:23-27
Competing interests: No competing interests