scholarly journals Do consultation charges deter general practitioner use among older people? A natural experiment

2009 ◽  
Vol 68 (8) ◽  
pp. 1432-1438 ◽  
Author(s):  
Richard Layte ◽  
Anne Nolan ◽  
Hannah McGee ◽  
Ann O'Hanlon
Keyword(s):  
General Practitioner ◽  
Older People ◽  
Natural Experiment

scholarly journals Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

2018 ◽  
Vol 42 (2) ◽  
pp. 181 ◽  
Author(s):  
Danielle Mazza ◽  
Christopher Pearce ◽  
Angela Joe ◽  
Lyle R. Turner ◽  
Bianca Brijnath ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Older People ◽  
Older Patients ◽  
Medical Officer ◽  
Public Hospitals ◽  
Out Of Hours ◽  
Gp Services ◽  
Emergency Department Utilisation ◽  
Lost Opportunity

Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.

Do suicide characteristics differ by age in older people?

2017 ◽  
Vol 30 (3) ◽  
pp. 323-330 ◽  
Author(s):  
Gary Cheung ◽  
Sally Merry ◽  
Frederick Sundram
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
General Practitioner ◽  
Older People ◽  
Suicide Risk ◽  
Psychiatric Services ◽  
Clinical Factors ◽  
Psychiatric Admission ◽  
Suicide Rates

ABSTRACTBackground:Suicide rates increase with age in the population aged over 65 years. The aims of this study were to (i) report the characteristics of older people who died by suicide; and (ii) investigate whether these characteristics differ in three age bands: 65–74 years, 75–84 years, and 85+ years.Methods:Using information from national coroner records, relevant socio-demographic and clinical factors in all suicides (age ≥ 65 years;n= 225) from July 2007 to December 2012 in New Zealand were analyzed and compared in the three age bands.Results:We found the older the person, the more likely they are to be widowed but the less likely to have a past psychiatric admission or recent contact with psychiatric services in the month prior to suicide. However, most of the older people (61.7% of 65–74 years, 65.6% of 75–84 years, and 77.3% of 85+ years) had contact with their general practitioner within one month of suicide. Women were less likely to use violent methods than men in all three age bands but with increasing age, men were less likely to use violent methods.Conclusions:Suicide characteristics in older people differ by age. The oldest people who die by suicide are not necessarily under psychiatric services and may benefit from a primary care-based approach in which there is screening for depression and suicide risk.

scholarly journals What do older people value when they visit their general practitioner? A qualitative study

2014 ◽  
Vol 11 (4) ◽  
pp. 361-367 ◽  
Author(s):  
Ludmila Marcinowicz ◽  
Teresa Pawlikowska ◽  
Marek Oleszczyk
Keyword(s):  
General Practitioner ◽  
Qualitative Study ◽  
Older People

The Nature of Depression Among Older People in Inner London, and the Contact with Primary Care

1994 ◽  
Vol 164 (3) ◽  
pp. 396-402 ◽  
Author(s):  
M. R. Blanchard ◽  
A. Waterreus ◽  
A. H. Mann
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Health Education ◽  
Older People ◽  
Self Care ◽  
Incidence Rates ◽  
Specific Therapy

Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having ‘probable pervasive depression’ were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for ‘probable pervasive depression’ and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS–AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS–AGECAT cases. Among subjects who had ‘probable pervasive depression’, 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS–AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.

scholarly journals Deprescribing to reduce polypharmacy: study protocol for a randomised controlled trial assessing deprescribing of anticholinergic and sedative drugs in a cohort of frail older people living in the community

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ulrich Bergler ◽  
Nagham J. Ailabouni ◽  
John W. Pickering ◽  
Sarah N. Hilmer ◽  
Dee Mangin ◽  
...  
Keyword(s):  
New Zealand ◽  
General Practitioner ◽  
Older People ◽  
Residential Care ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Trial Registration ◽  
Home Support ◽  
Sedative Drugs ◽  
Randomised Controlled

Abstract Background Targeted deprescribing of anticholinergic and sedative medications in older people may improve their health outcomes. This trial will determine if pharmacist-led reviews lead to general practitioners deprescribing anticholinergic and sedative medications in older people living in the community. Methods and analysis The standard protocol items: Recommendations for Interventional Trials (SPIRIT) checklist was used to develop and report the protocol. The trial will involve older adults stratified by frailty (low, medium, and high). This will be a pragmatic two-arm randomized controlled trial to test general practitioner uptake of pharmacist recommendations to deprescribe anticholinergic and sedative medications that are causing adverse side effects in patients. Study population Community-dwelling frail adults, 65 years or older, living in the Canterbury region of New Zealand, seeking publicly funded home support services or admission to aged residential care and taking at least one anticholinergic or sedative medication regularly. Intervention New Zealand registered pharmacists using peer-reviewed deprescribing guidelines will visit participants at home in the community, review their medications, and recommend anticholinergic and sedative medications that could be deprescribed to the participant’s general practitioner. The total use of anticholinergic and sedative medications will be quantified using the Drug Burden Index (DBI). Outcomes The primary outcome will be the change in total DBI between baseline and 6-month follow-up. Secondary outcomes will include entry into aged residential care, prolonged hospitalization, and death. Data collection points Data will be collected at the time of interRAI assessments (T0), at the time of the baseline review (T1), at 6 months following the baseline review (T2), and at the end of the study period, or end of study participation for participants admitted into aged residential care, or who died (T3). Ethics and dissemination Ethical approval has been obtained from the Human, Disability and Ethics Committee: ethical number (17CEN265). Trial registration ClinicalTrials.gov ACTRN12618000729224. Registered on May 2, 2018, with the Australian New Zealand Clinical Trials Registry

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