A qualitative study of the experience of GP supervisors and GP registrars in the management of older patients with chronic disease
A study based in General Practice Training Tasmania. GP Synergy Research & Evaluation Unit members Professor Parker Magin and Ms Amanda Tapley are collaborating with researchers from General Practice Training Tasmania, the University of Tasmania and the University of Wollongong on this project. The project lead is Dr Rohan Kerr from General practice Training Tasmania.
From ReCEnT data we know that registrars see considerably fewer patients aged older than 65 than do established GPs (17.6% of consultations versus 32.5%).
Several aspects of registrars’ consultations with older patients suggest that consultations would be more complex than those with younger patients. Chronic disease in older patient consults is more frequent than in younger patient consults and chronic disease consultations are longer, contain more problems, result in more specialist referrals and are more likely to result in generation of learning goals. Additionally, registrars’ consultations with older patients, compared with consultations with younger patients, involve more patient problems per consultation and are more likely to be with NESB patients. Despite these indications of complexity in older patient consultations, compared with younger patient consults, ReCEnT data suggests they are shorter, result in fewer learning goals being generated and entail less recourse to Supervisor advice or assistance.
Furthermore, in terms of continuity of care, older age is very strongly associated with review being arranged with another doctor in the practice rather than the registrar. Thus, the educational quality of these consultations seems to be poorer than would be expected.
Registrars may be taking less responsibility and less of an active management role in older patients.
The ACTOR qualitative study involves interviews with registrars and supervisors and aims to explore barriers to greater exposure to, engagement with and continuity of care of older patients with chronic disease and to explore ideas on overcoming these barriers/establishing structures to provide greater exposure, engagement and continuity of care. It also aims to elicit and refine supervisors’ and registrars’ ideas for registrar-supervisor shared care models in aged care.
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