title: GPs' perspectives on preventive care for older people: a focus group study.
abstract: BACKGROUND
  Preventive care traditionally aims to prevent diseases or injuries. For older people, different aims of prevention, such as maintenance of independence and wellbeing, are increasingly important.
  
  
  OBJECTIVE
  To explore GPs' perspectives on preventive  care for older people.
  
  
  METHODS
  Qualitative study comprising six focus groups with GPs in the Netherlands.
  
  
  METHODS
  The focus-group discussions with 37 GPs were analysed using the framework analysis method.
  
  
  RESULTS
  Whether  or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request; when the  vitality levels in older people fall, the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based  on these perspectives, a conceptual model for preventive care was developed, which describes GPs' different perspectives toward older people who are vulnerable and those with high levels of vitality. It focuses on five main dimensions: aim of care (prevention of disease versus prevention  of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline).
  
  
  CONCLUSIONS
  GPs' perspectives on preventive care are determined by their perception of the level of vitality of their older patients. Preventive care for older people with high levels of vitality may consist of a standardised disease-oriented approach; those who are vulnerable  will need an individualised approach to prevent functional decline.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. y.m.drewes@lumc.nl
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Drewes
authors.forename: Julia M
authors.initials: JM
authors.lastname: Koenen
authors.forename: Wouter
authors.initials: W
authors.lastname: de Ruijter
authors.forename: D J Annemarie
authors.initials: DJ
authors.lastname: van Dijk-van Dijk
authors.forename: Gerda M
authors.initials: GM
authors.lastname: van der Weele
authors.forename: Barend J C
authors.initials: BJ
authors.lastname: Middelkoop
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011315:Preventive Medicine / Q000458:organization & administration*; D036301:Qualitative Research; D011788:Quality of Life