title: Physician perspectives on medical care delivery in assisted living.
abstract: OBJECTIVE
  To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  AL communities in 27 states.
  
  
  METHODS
  One hundred sixty-five physicians and administrators of 125 AL settings in which they had patients.
  
  
  METHODS
  Interviews and questionnaires containing open- and close-ended questions regarding demographics, care arrangements, attitudes, and behaviors in managing medical problems.
  
  
  RESULTS
  Most respondents were certified in internal medicine (46%) or family medicine (47%); 32% were certified in geriatrics and 30% in medical directorship. In this select sample, 48% visited the AL setting once a year or less, and 19% visited once a week or more. Mean physician confidence in AL staff was 3.3 (somewhat confident), with greater confidence associated with smaller AL community size, nursing presence, and the physician being the medical director. Qualitative analyses identified differences between settings including lack of vital sign assessment in the home setting, concern about the ability of AL staff to assess and monitor problems, and greater administrative and regulatory requirements in AL than in the other settings.
  
  
  CONCLUSIONS
  Providing medical care for AL residents presents unique challenges and opportunities for physicians. Nursing presence and physician oversight and familiarity and communicating with AL staff who are highly familiar with a given resident and can monitor care may facilitate care.
authors.affiliation: Department of Family Medicine; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. philip_sloane@med.unc.edu
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Rosa
authors.initials: R
authors.lastname: Perez
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.forename: Brandy
authors.initials: B
authors.lastname: Harris-Wallace
authors.forename: Christine
authors.initials: C
authors.lastname: Khandelwal
authors.forename: Anna Song
authors.initials: AS
authors.lastname: Beeber
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
authors.forename: John
authors.initials: J
authors.lastname: Schumacher
mesh_terms: D000368:Aged; D040561:Assisted Living Facilities; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010820:Physicians; D011787:Quality of Health Care
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