title: Out of sight, out of mind? Does terminating the physical presence of a geriatric consultant in the community clinic reduce the implementation rate for geriatric recommendations.
abstract: OBJECTIVE
  To assess the effect of moving the geriatric consultation from the primary care clinic to another setting, on the rate of implementation of geriatric recommendations by family physicians.
  
  
  METHODS
  A retrospective review of the computerized medical records of elderly patients in four primary care clinics. The rate of implementation of geriatric recommendations was compared between clinics in which a geriatric consultant was physically present (control clinics) and a clinic where the consultation took place elsewhere (study clinic). In addition, the results of the present study were compared to a previous study in which the geriatric consultation was carried out in the study clinic and the family doctor was an active participant.
  
  
  RESULTS
  127 computerized files were reviewed in the study clinic and 133 in the control clinics. The mean age of the patients was 81.1±6.3 years and 63.1% were women. The overall implementation of geriatric recommendations by family doctors in the study clinic was 55.9%, a statistically significant decrease compared to the previous study where the rate was 73.9% (p<0.0001). In contrast, there was no change in the implementation rate in the control clinics at 65.0% in the present study and 59.9% in the previous one (p=0.205).
  
  
  CONCLUSIONS
  Direct, person-to-person contact between the geriatric consultant and the family doctor has a beneficial effect on the implementation of geriatric recommendations. This should be considered by healthcare policy makers when planning geriatric services in the community.
authors: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel. Electronic address: freudt@bgu.ac.il.
authors: Tamar
authors: T
authors: Freud
authors: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, 24 King David St., Beer-Sheva 84541, Israel; Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, Israel. Electronic address: borispu@clalit.org.il.
authors: Boris
authors: B
authors: Punchik
authors: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; Clalit Health Services, Southern District, KENYON HANEGEV Towers, 3rd floor, Beer-Sheva, Israel. Electronic address: ayabi@clalit.org.il.
authors: Aya
authors: A
authors: Biderman
authors: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; Clalit Health Services, Southern District, KENYON HANEGEV Towers, 3rd floor, Beer-Sheva, Israel. Electronic address: pelegr@bgu.ac.il.
authors: Roni
authors: R
authors: Peleg
authors: Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, 24 King David St., Beer-Sheva 84541, Israel. Electronic address: drellaka1@clalit.org.il.
authors: Ella
authors: E
authors: Kagan
authors: Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, 24 King David St., Beer-Sheva 84541, Israel. Electronic address: alexbar@clalit.org.il.
authors: Alex
authors: A
authors: Barzak
authors: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel; Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, 24 King David St., Beer-Sheva 84541, Israel; Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva, Israel. Electronic address: yanpr@clalit.org.il.
authors: Yan
authors: Y
authors: Press
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D003153:Community Health Services; D003253:Consultants; D003266:Continuity of Patient Care; D005260:Female; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010819:Physician's Role; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Community dwelling; Geriatric assessment; Implementation of recommendations