Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges, opportunities and potential solutions from a primary healthcare provider perspective.
Fifty-seven participants joined in group discussions on challenges and opportunities of working with advanced age. Participants included general practitioners (GPs), practice nurses, students and administration staff working in ten general practices. A thematic analysis was developed, supported by NVivo software.
Poor lines of communication and fragmentation of services between differing levels of health care services available for older people were highlighted. This has implications for quality of care and equity of services. Participants also reported challenges in treatment and funding regimes.
The small sample size and regional nature of the study, along with the semi-structured nature of the group discussions and rigorous thematic analysis, indicate that this qualitative data is transferable, dependable, confirmable and credible. Comparing the views of tertiary and community services would be useful.
A range of potential strategies and solutions to the current fragmented services was offered by GPs. For example, adequately funded and staffed community-based health hubs; IT platforms enabling timely flow of patient information between primary and tertiary health providers and creation of medical, nursing and allied health roles aimed at improving synergy between GP and tertiary services.
Obtaining the perspectives of general practice highlights the challenges and complexities of caring for those in advanced age brings. These insights have not been previously been explored in-depth within this setting in New Zealand.
The authors are grateful to our practice participants for sharing their views and time with us, and to the University of Auckland Faculty of Medical and Health Research Development Fund for funding the research. The authors also thank the anonymous reviewers for their constructive suggestions.
Miskelly, P., Kerse, N. and Wiles, J. (2020), "Joining-the-dots: caring for patients in advanced age", Quality in Ageing and Older Adults, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/QAOA-08-2019-0042Download as .RIS
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