Limits...
What is important, what needs treating? How GPs perceive older patients' multiple health problems: a mixed method research study.

Junius-Walker U, Wrede J, Schleef T, Diederichs-Egidi H, Wiese B, Hummers-Pradier E, Dierks ML - BMC Res Notes (2012)

Bottom Line: Prior to the interviews, the GPs had received a list of their patients' health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem.Here, patient empowerment strategies are of value and need to be developed and implemented.To this end, GPs need to be able to delegate care to a functioning primary care team.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of General Practice, Hannover Medical School, Hannover, Germany. junius-walker.ulrike@mh-hannover.de

ABSTRACT

Background: GPs increasingly deal with multiple health problems of their older patients. They have to apply a hierarchical management approach that considers priorities to balance competing needs for treatment. Yet, the practice of setting individual priorities in older patients is largely unexplored. This paper analyses the GPs' perceptions on important and unimportant health problems and how these affect their treatment.

Methods: GPs appraised the importance of health problems for a purposive sample of their older patients in semi-structured interviews. Prior to the interviews, the GPs had received a list of their patients' health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem. In the interviews the GPs subsequently explained why they considered certain health problems important or not and how this affected treatment. Data was analysed using qualitative content analysis and quantitative methods.

Results: The problems GPs perceive as important are those that are medical and require active treatment or monitoring, or that induce empathy or awareness but cannot be assisted further. Unimportant problems are those that are well managed problems and need no further attention as well as age-related conditions or functional disabilities that provoke fatalism, or those considered outside the GPs' responsibility. Statements of professional actions are closely linked to explanations of important problems and relate to physical problems rather than functional and social patient issues.

Conclusions: GPs tend to prioritise treatable clinical conditions. Treatment approaches are, however, vague or missing for complex chronic illnesses and disabilities. Here, patient empowerment strategies are of value and need to be developed and implemented. The professional concepts of ageing and disability should not impede but rather foster treatment and care. To this end, GPs need to be able to delegate care to a functioning primary care team.

Trial registration: German Trial Register (DRKS): 00000792.

Show MeSH

Related in: MedlinePlus

Coding of citations – an example. (1) reasons for unimportance: inductively developed categories. (2) dedicated health domain. (3) declaration of treatment on a scale: (−1) no declaration, (0) no treatment, (1) treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3475051&req=5

Figure 1: Coding of citations – an example. (1) reasons for unimportance: inductively developed categories. (2) dedicated health domain. (3) declaration of treatment on a scale: (−1) no declaration, (0) no treatment, (1) treatment.

Mentions: All 35 interviews were audio-recorded and transcribed verbatim. JW and HDE independently marked all quotations on the importance of health problems. Qualitative content-analysis involved paraphrasing, reducing and abstracting the GPs’ quotations to inductively develop categories in an iterative approach. TS and UJW revisited all quotations to assign to each one: (1) one or more categories according to the reason for its importance (with a primary reason marked if several reasons were given), (2) the appropriate health domain, and (3) any statement about treatment scaled according to ‘no statement’, ‘no treatment necessary or possible’, ‘treatment intended or continued’ (Figure 1). Any disparate opinions were discussed in the team with MLD.


What is important, what needs treating? How GPs perceive older patients' multiple health problems: a mixed method research study.

Junius-Walker U, Wrede J, Schleef T, Diederichs-Egidi H, Wiese B, Hummers-Pradier E, Dierks ML - BMC Res Notes (2012)

Coding of citations – an example. (1) reasons for unimportance: inductively developed categories. (2) dedicated health domain. (3) declaration of treatment on a scale: (−1) no declaration, (0) no treatment, (1) treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475051&req=5

Figure 1: Coding of citations – an example. (1) reasons for unimportance: inductively developed categories. (2) dedicated health domain. (3) declaration of treatment on a scale: (−1) no declaration, (0) no treatment, (1) treatment.
Mentions: All 35 interviews were audio-recorded and transcribed verbatim. JW and HDE independently marked all quotations on the importance of health problems. Qualitative content-analysis involved paraphrasing, reducing and abstracting the GPs’ quotations to inductively develop categories in an iterative approach. TS and UJW revisited all quotations to assign to each one: (1) one or more categories according to the reason for its importance (with a primary reason marked if several reasons were given), (2) the appropriate health domain, and (3) any statement about treatment scaled according to ‘no statement’, ‘no treatment necessary or possible’, ‘treatment intended or continued’ (Figure 1). Any disparate opinions were discussed in the team with MLD.

Bottom Line: Prior to the interviews, the GPs had received a list of their patients' health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem.Here, patient empowerment strategies are of value and need to be developed and implemented.To this end, GPs need to be able to delegate care to a functioning primary care team.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of General Practice, Hannover Medical School, Hannover, Germany. junius-walker.ulrike@mh-hannover.de

ABSTRACT

Background: GPs increasingly deal with multiple health problems of their older patients. They have to apply a hierarchical management approach that considers priorities to balance competing needs for treatment. Yet, the practice of setting individual priorities in older patients is largely unexplored. This paper analyses the GPs' perceptions on important and unimportant health problems and how these affect their treatment.

Methods: GPs appraised the importance of health problems for a purposive sample of their older patients in semi-structured interviews. Prior to the interviews, the GPs had received a list of their patients' health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem. In the interviews the GPs subsequently explained why they considered certain health problems important or not and how this affected treatment. Data was analysed using qualitative content analysis and quantitative methods.

Results: The problems GPs perceive as important are those that are medical and require active treatment or monitoring, or that induce empathy or awareness but cannot be assisted further. Unimportant problems are those that are well managed problems and need no further attention as well as age-related conditions or functional disabilities that provoke fatalism, or those considered outside the GPs' responsibility. Statements of professional actions are closely linked to explanations of important problems and relate to physical problems rather than functional and social patient issues.

Conclusions: GPs tend to prioritise treatable clinical conditions. Treatment approaches are, however, vague or missing for complex chronic illnesses and disabilities. Here, patient empowerment strategies are of value and need to be developed and implemented. The professional concepts of ageing and disability should not impede but rather foster treatment and care. To this end, GPs need to be able to delegate care to a functioning primary care team.

Trial registration: German Trial Register (DRKS): 00000792.

Show MeSH
Related in: MedlinePlus