A study released online in the September issue of the journal Health Affairs reports on how primary care and geriatric practices provide care for older adults, especially those who are frail with high health needs. Understanding how best to provide and arrange care for older adults is critical as the population ages and primary care and geriatric clinician shortages persist in the U.S.
The study findings stress that primary care clinicians that work in interprofessional teams including registered nurses, social workers and community health workers, provide less expensive care and are able to better assess the needs of older adults.
Karen Donelan, the Stuart H. Altman Professor of U.S. Health Policy at Brandeis University, led the study with funding from the Gordon and Betty Moore Foundation. She reflected, “Many clinical practices seem to struggle to meet the wide-ranging needs of frail older adults, whose numbers are growing each year. We need to help clinicians develop strategies to meet patient needs while not burning out. Well-staffed teams may provide one way to cope with the surge in demand.”
Based on an analysis of a major national survey of clinicians at more than 300 clinical practices in the U.S. conducted prior to the coronavirus pandemic, the researchers compared practices with predominantly physician labor (“high MD”) with those with more nurse practitioner and physician assistant providers (“high NP/PA”) and those with team-based care involving registered nurses, social workers and community health workers (“Team Care”).
Lead author David Auerbach noted that “The findings from our detailed survey of primary care practices confirmed what we had seen earlier in site visits - that those that deployed a mix of providers, including RNs, nurse practitioners, PAs, social workers and community health workers, working alongside physicians, appeared to deliver broader, more comprehensive care to their frail elderly patients."
Among the key findings:
- Practices with more NP/PA and Team Care were more likely to facilitate care for older adults either through transportation to visits, telehealth or care in the home.
- Practices with Team Care were more likely to provide a full array of primary care services to older adults.
- Practices with a higher share of funding from Medicaid were more likely to use team-based care models, and lower labor cost.
- Practices with more NP and PA providers are more likely to have geriatric or gerontology expertise among the practice staff.
The research team included national experts from Massachusetts General Hospital, Simmons School of Social Work, Montana State University, Vanderbilt University, the University of California at San Francisco and Mathematica.