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NPs valuable in care of chronic geriatric conditions

Wednesday June 26, 2013
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A new study highlights the central role nurse practitioners can play in treating chronic geriatric conditions.

Researchers with the David Geffen School of Medicine at UCLA screened 1,084 patients at two primary care facilities in Southern California for four chronic geriatric conditions: falls, urinary incontinence, dementia/Alzheimer’s disease and depression. Of those patients, 658 had at least one condition; 485 of the 658 were randomly selected for medical review.

Of those 485 patients, 237 (49%) were seen by a nurse practitioner for co-management with a primary care physician of at least one condition. The rest were seen only by a primary care physician.

As reported in the June issue of the Journal of the American Geriatrics Society, the researchers examined whether a set of measures known as Assessing Care of Vulnerable Elders quality indicators were performed for each condition. For patients whose cases were co-managed by a nurse practitioner and a physician, the percentage of quality indicators that were satisfied was higher than for patients seen only by a physician.

For falls, 80% of quality indicators were satisfied for co-managed cases, compared with 34% for physicians alone; for urinary incontinence, 66% of indicators were satisfied, compared with 19%; for dementia, 59% were satisfied, compared with 38%; and for depression, 63% were satisfied, compared with 60%.

Much of the difference stemmed the fact that the nurses were likely to take far more detailed patient histories and to perform other assessments, according to the researchers. For instance, the pass rates — meaning whether the measure was performed — for taking a patient’s history of falls was 91% for co-managed cases, versus 47%; vision testing was 87%, versus 36%; and discussion of treatment options for urinary incontinence was 79%, versus 28%.

David B. Reuben, MD, the study’s lead author and chief of the geriatrics division in the Department of Medicine at the Geffen School of Medicine, noted that while physicians typically are adept at treating acute medical conditions and conditions requiring highly complex decision-making, they may overlook chronic conditions or not have the time to address them sufficiently.

The findings were limited by several facts, the researchers said. Some cases primary care physicians considered "mild" were not referred for co-management. Also, the study was conducted in only two facilities within a single geographic area, and consisted of a one-time intervention with minor revisions as the study went along rather than a longer, continuous learning process.

Read the study abstract: http://onlinelibrary.wiley.com/doi/10.1111/jgs.12268/abstract.


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