Improving Primary Care for Older Patients: Challenge for the Aging Century Comment on “Practice Redesign to Improve Care for Falls and Urinary Incontinence” Improving Primary Care for Older Patients

Kao H, Landefeld C. — Mon, 25 Oct 2010 00:00:00 GMT

We have entered the aging century. The global population older than 65 years will double by 2040, with the most rapid increase among people older than 80 years. The aging of populations will challenge health care systems around the world: not only will greater numbers of people have chronic diseases, such as heart failure or cancer, but also many will develop disabling geriatric conditions, such as dementia, difficulty walking, falling, or incontinence. Geriatric conditions are underdiagnosed, and their treatment requires expertise beyond a prescription or surgery. These complex conditions diminish the length and quality of life and the ability of individuals to engage in society.

Practice Redesign to Improve Care for Falls and Urinary Incontinence Primary Care Intervention for Older Patients Care Improvement for Falls and Incontinence

Wenger NS, Roth CP, Hall WJ, et al. — Mon, 25 Oct 2010 00:00:00 GMT

Background

In primary care, medical care for age-associated conditions, such as falls and urinary incontinence (UI), is inadequate. In collaboration with the American College of Physicians, we augmented the Assessing Care of Vulnerable Elders practice redesign intervention to improve falls and UI care.

Methods

We performed a controlled trial in 5 nonrandomly selected primary care intervention (26 physicians across sites) and control (18 physicians) practices from diverse communities. Patients 75 years and older who screened positive for falls or fear of falling and UI were included in the study. We conducted a multicomponent intervention between October 30, 2006, and December 31, 2007, that included efficient collection of data, medical record prompts, patient education materials, and physician decision support. Main outcome measures were quality of care for falls and UI comparing intervention and control sites.

Results

Of 6051 patients screened, 2847 (47.1%) screened positive for falls or UI (46.1% in the intervention group and 48.8% in the control group). Across the 5 practices, 1211 patient medical records were evaluated after stratified random selection. Intervention patients received 60.0% of recommended care for falls vs 37.6% provided by control health care professionals (P < .001). Similarly, intervention health care professionals provided more recommended care for UI (47.2% vs 27.8%, P < .001). Intervention health care professionals more often performed a falls history, orthostatic blood pressure measurement, gait and balance examination, and UI history and tried UI behavioral treatments first. Knowledge about falls and UI increased more among intervention than control group health care professionals.

Conclusions

Practice redesign can improve the care that community-based primary care physicians provide for older patients with falls and UI. Outcomes of such care improvements require further evaluation.

JAMA Internal Medicine: Incontinence Topic Collection

Improving Primary Care for Older Patients: Challenge for the Aging Century Comment on “Practice Redesign to Improve Care for Falls and Urinary Incontinence” Improving Primary Care for Older Patients

Practice Redesign to Improve Care for Falls and Urinary Incontinence Primary Care Intervention for Older Patients Care Improvement for Falls and Incontinence