Usual primary care of older people in New Zealand: association between practice characteristics and practice activities
Leah Palapar 1 , Laura Wilkinson-Meyers 2 , Thomas Lumley 3 , Ngaire Kerse 11 Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
2 Health Systems Section, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
3 Department of Statistics, Faculty of Science, University of Auckland, New Zealand
Correspondence to: Ngaire Kerse, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Email: n.kerse@auckland.ac.nz
Journal of Primary Health Care 9(1) 78-84 https://doi.org/10.1071/HC16039
Published: 7 March 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Information on the processes used by primary care practices to help identify older patients in need of assistance are limited in New Zealand.
AIM: To describe the processes used to promote early problem detection in older patients in primary care and the practice characteristics associated with the use of these proactive processes.
METHODS: Sixty practices were randomly selected from all primary care practices in three regions (52% response rate) and surveyed in 2010 to identify characteristics of practices performing the following activities: using assessment tools; auditing the practice; conducting specific clinics; providing home visits; and providing active patient follow-up. Practice level variables were examined.
RESULTS: Only 4 (7%) of 57 practices did not perform any of the activities. We found the following associations in the many comparisons done: no activities and greater level of deprivation of practice address (p = 0.048); more activities in main urban centres (p = 0.034); more main urban centre practices doing home visits (p = 0.001); less Canterbury practices conducting specific clinics for frail older patients (p = 0.010); and more Capital and Coast practices following-up patients who do not renew their prescriptions (p = 0.019).
DISCUSSION: There are proactive processes in place in most New Zealand practices interested in a trial about care of older people. Future research should determine whether different types of practices or the activities that they undertake make a difference to older primary care patients’ outcomes.
KEYWORDS: Practice patterns; geriatric assessment; needs assessment; general practice standards
References
[1] Lacas A, Rockwood K. Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med 2012; 10[2] Huss A, Stuck AE, Rubenstein LZ, et al. Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol 2008; 63 298–307.
| Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar |
[3] Beswick AD, Rees K, Dieppe P, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 2008; 371 725–35.
| Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[4] Fletcher A. Multidimensional assessment of elderly people in the community. Br Med Bull 1998; 54 945–60.
| Multidimensional assessment of elderly people in the community.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3psFGjsw%3D%3D&md5=9ced5405f67efaa129aa980c7a9d0e45CAS |
[5] Kerse N, Boyd M, McLean C, et al. Utility of a primary health care case finding tool to identify older people with disability, the BRIGHT tool. Age Ageing 2008; 37 553–8.
| Utility of a primary health care case finding tool to identify older people with disability, the BRIGHT tool.Crossref | GoogleScholarGoogle Scholar |
[6] Kerse N, McLean C, Moyes SA, et al. The cluster-randomized BRIGHT trial: proactive case finding for community-dwelling older adults. Ann Fam Med 2014; 12 514–24.
| The cluster-randomized BRIGHT trial: proactive case finding for community-dwelling older adults.Crossref | GoogleScholarGoogle Scholar |
[7] Metzelthin SF, van Rossum E, de Witte LP, et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ 2013; 347 f5264
| Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[8] Rubenstein LZ, Alessi CA, Josephson KR, et al. A randomized trial of a screening, case finding, and referral system for older veterans in primary care. J Am Geriatr Soc 2007; 55 166–74.
| A randomized trial of a screening, case finding, and referral system for older veterans in primary care.Crossref | GoogleScholarGoogle Scholar |
[9] Parsons M, Senior H, Mei-Hu Chen X, et al. Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand. Health Soc Care Community 2013; 21 536–44.
| Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand.Crossref | GoogleScholarGoogle Scholar |
[10] Ploeg J, Brazil K, Hutchison B, et al. Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial. BMJ 2010; 340 c1480
| Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[11] van Hout HPJ, Jansen APD, van Marwijk HWJ, et al. Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomized controlled trial [ISRCTN05358495]. J Gerontol A Biol Sci Med Sci 2010; 65A 734–42.
| Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomized controlled trial [ISRCTN05358495].Crossref | GoogleScholarGoogle Scholar |
[12] De Lepeleire J, Iliffe S, Mann E, Degryse J. Frailty: an emerging concept for general practice. Br J Gen Pract 2009; 59 e177–82.
| Frailty: an emerging concept for general practice.Crossref | GoogleScholarGoogle Scholar |
[13] Beswick AD, et al. . Maintaining independence in older people. Rev Clin Gerontol 2010; 20 128–53.
| Maintaining independence in older people.Crossref | GoogleScholarGoogle Scholar |
[14] Pande M. A Profile of New Zealand General Practices in 2007. Royal New Zealand College of General Practitioners; 2008. Occasional Paper 9.
[15] Schoen C, Osborn R, Squires D, et al. A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Affairs 2012; 31 2805–16.
[16] Centre for Primary Health Care and Equity. Managing chronic disease: what makes a general practice effective? 2006 [cited 2015 August 20]. Available from: https://cphce.unsw.edu.au/research/prevention-management-chronic-diseases/practice-capacity-chronic-disease-management.
[17] Barton C, Proudfoot J, Amoroso C, et al. Management of asthma in Australian general practice: Care is still not in line with clinical practice guidelines. Prim Care Respir J 2009; 18 100–5.
| Management of asthma in Australian general practice: Care is still not in line with clinical practice guidelines.Crossref | GoogleScholarGoogle Scholar |
[18] Campbell SM, Hann M, Hacker J, et al. Identifying predictors of high quality care in English general practice: Observational study. BMJ 2001; 323 784
| Identifying predictors of high quality care in English general practice: Observational study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrktV2qtA%3D%3D&md5=9a54bf9cb3e1ce0848ef8341d5c58f1fCAS |
[19] Ashworth M, Armstrong D. The relationship between general practice characteristics and quality of care: A national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5. BMC Fam Pract 2006; 7
[20] Kelly E, Stoye G. Does GP Practice Size Matter? GP Practice Size and the Quality of Primary Care. London: 2014 IFS Report R101.
[21] McLean C, Kerse N, Moyes SA, et al. Recruiting older people for research through general practice: The Brief Risk Identification Geriatric Health Tool trial. Australas J Ageing 2014; 33 257–63.
| Recruiting older people for research through general practice: The Brief Risk Identification Geriatric Health Tool trial.Crossref | GoogleScholarGoogle Scholar |
[22] Wilkinson-Meyers L, Brown P, McLean C, Kerse N. Met and unmet need for personal assistance among community-dwelling New Zealanders 75 years and over. Health Soc Care Community 2014; 22 317–27.
| Met and unmet need for personal assistance among community-dwelling New Zealanders 75 years and over.Crossref | GoogleScholarGoogle Scholar |
[23] Statistics New Zealand. Classification Coding System. Version 4.0.2 [software]. 2014 [cited 2015 Feb 3]. Available from: www.stats.govt.nz/methods/classifications-and-standards/classification-related-stats-standards/download-the-classification-coding-system.aspx
[24] Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation. Wellington: Department of Public Health, University of Otago; 2007.
[25] Crampton P, Jatrana S, Lay-Yee R, Davis P. Exposure to primary medical care in New Zealand: number and duration of general practitioner visits. N Z Med J 2007; 120 U2582.
[26] Brown PM, Wilkinson-Meyers L, Parsons M, et al. Cost of prescribed and delivered health services resulting from a comprehensive geriatric assessment tool in New Zealand. Health Soc Care Community 2009; 17 514–21.
| Cost of prescribed and delivered health services resulting from a comprehensive geriatric assessment tool in New Zealand.Crossref | GoogleScholarGoogle Scholar |
