A comparison of how generalists and fellowship-trained geriatricians provide "geriatric" care.
OBJECTIVE
To determine whether outpatient care provided to older patients by fellowship-trained geriatricians is distinguishable from that provided by generalists.


METHODS
Observational study.


METHODS
Three primary care clinics of an academic medical center.


METHODS
Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.


METHODS
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 (beta coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57-8.94).


CONCLUSIONS
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.
Phelan
Elizabeth A
EA
Department of Medicine, Divisions of Gerontology and Geriatric Medicine, , University of Washington, Seattle, Washington 98104, USA. phelane@u.washington.edu
Genshaft
Scott
S
Williams
Barbara
B
LoGerfo
James P
JP
Wagner
Edward H
EH
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015897:Comorbidity; D004358:Drug Therapy; D005257:Fellowships and Scholarships; D015577:Geriatric Assessment; D005853:Geriatrics / Q000193:education / Q000706:statistics & numerical data; D006299:Health Services for the Aged; D006801:Humans; D010821:Physicians, Family / Q000706:statistics & numerical data; D011320:Primary Health Care; D011787:Quality of Health Care