Purpose: The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care. Methods: We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in…

Previous research has been conducted regarding preferences of physicians for life-sustaining treatments for themselves, but there is a dearth of data on personal use of advance directives (ADs) by geriatricians specifically. Using a phone survey, we contacted all graduates of the geriatric fellowship program to assess their personal use of advance…

Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

Examined knowledge of geriatric health policies of 154 physicians training in medicine, surgery, and psychiatry. Found a widespread lack of knowledge that could interfere with physicians' ability to use the health care system appropriately for patients' benefit and to function effectively as a gatekeeper to health care utilization. (Author/ABL)

The study analyzes physician and hospital utilization patterns of the elderly using 1969 data from the Health Interview Survey conducted by the National Center for Health Statistics to determine why Medicare payments to high income elderly persons are much higher than to low income elderly persons. (Author/BP)

Evaluated medical residents and discovered that although they considered detection and treatment of comorbid depression to be important, they knew few of the diagnostic criteria and etiological factors, rarely screened patients for depression and viewed current treatments as only marginally efficacious. Discusses implications for graduate…

Examined models for predicting treatment decisions of physicians, nurses, and social workers within acute and long-term care settings. Elicited treatment choices to vignettes regarding decisions to allocate scarce medical resource and to withhold treatment from debilitated patient. Primarily medical factors predicted decision to allocate…

Comparison of opinions of residents in two programs providing different amounts of geriatric training concerning management of four geriatric and two traditional internal medicine problems found all had less confidence about geriatric than traditional problems. Students with more training offered more support for nondiscriminatory care of elderly…

A pilot program at the University of California, Davis, that incorporated skilled nursing facility training into the required curriculum of their primary care internal medicine residency is described. The goal was to increase the residents' knowledge in the care of geriatric patients. (MLW)

Pharmacists (N=233) responded to the question "What is the most difficult aspect of geriatric pharmacy practice?" Most commonly cited problems were (1) inadequate professional skills or knowledge in geriatrics; (2) patient compliance; (3) physician functioning (including overprescribing of medications); (4) communication with the elderly; (5) lack…

Forces acting on medical education and compelling a reexamination of current approaches include cost containment, competition and price sensitivity, new technologies, the physician surplus, and a rapidly expanding, politically assertive aging population. (MSE)

This background paper, prepared by two members of the Institute of Medicine's Committee on Strengthening the Geriatric Content of Medical Education, addresses the progress made in physicians' geriatric and gerontological education. The report appears in six chapters. After a brief introduction on health care reform and medical education, geriatric…

Increasingly, the health care needs of older people are dominating the field of medicine and the health care system. The supply of physician gerontologists and geriatricians, the attention they pay to the special needs of the elderly, and the adequacy of their training are addressed in these hearings, which consider a Senate bill to improve the…

Demographic and utilization date are used to project the need for physicians to provide care for the elderly over the next 50 years. The quantitative estimates are coupled with qualitative analyses leading to recommendations for means to deliver the needed services. Estimates are that the United States will require about 8,000 geriatricians by…

Regulations instituted by the Department of Health, Education, and Welfare effective in 1976 require skilled nursing facilities (SNF) to provide either a physician serving as medical director, or to have an organized medical staff. This report describes how SNFs responded, and what the effects were on their operations. Descriptive data were…