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A Comparison of How Generalists and Fellowship‐Trained Geriatricians Provide “Geriatric” Care
Author(s) -
Phelan Elizabeth A.,
Genshaft Scott,
Williams Barbara,
LoGerfo James P.,
Wagner Edward H.
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2008.01942.x
Subject(s) - medicine , specialty , geriatrics , family medicine , primary care , observational study , generalist and specialist species , confidence interval , gerontology , psychiatry , ecology , habitat , biology
OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists. DESIGN: Observational study. SETTING: Three primary care clinics of an academic medical center. PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics. MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was abstracted. RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 ( P <.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P <.001; 95% confidence interval=4.57–8.94). CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.