title: Clinic-based primary care of frail older patients in California.
abstract: We surveyed medical directors of primary care clinics in California to learn how those clinics cared for their frail older patients. Of 143 questionnaires sent, 127 (89%) were returned. A median of 30% of all patient encounters were with persons aged 65 or older, and a median of 20% of older patients were considered frail. A total of 20% of the clinics routinely provided house calls to homebound elderly patients. Of clinics involved in training medical students of physicians (teaching clinics), 70% had at least one physician with an interest in geriatrics, compared with 42% of nonteaching clinics (P less than .005). For frail patients, 40% of the clinics routinely performed functional assessment, while 20% routinely did an interdisciplinary evaluation. Continuing education in geriatrics emerged as a significant independent correlate of both functional assessment and interdisciplinary evaluation. Among the 94 clinics with a standard appointment length for the history and physical examination, only 11 (12%) allotted more than 60 minutes for frail patients. The data suggest that certain geriatric approaches are being incorporated into clinic-based primary care in California but do not provide insight into their content or clinical effects.
authors.affiliation: Division of General Medicine, University of California, Davis, School of Medicine.
authors.forename: C H
authors.initials: CH
authors.lastname: Hirsch
authors.forename: C H
authors.initials: CH
authors.lastname: Winograd
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D002140:California; D003151:Community Health Centers; D004502:Education, Medical, Continuing; D016330:Frail Elderly; D005853:Geriatrics / Q000193:education; D006123:Group Practice; D006766:Hospitals, County; D016304:Hospitals, Private; D006787:Hospitals, Veterans; D006792:House Calls; D006801:Humans; D008487:Medical History Taking; D015442:Medicare Assignment; D010044:Outpatient Clinics, Hospital; D010347:Patient Care Planning; D010808:Physical Examination; D011320:Primary Health Care; D012947:Social Work; D013997:Time Factors; D014481:United States