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Woman looking at medicine while team discuss her case

Tips for a more rewarding visit with your family physician

Nov 12, 2014 - McMaster University -

The Bottom Line

Many older adults have multiple health conditions, for which they are on multiple medications and treatments. Research from focus group and survey data with older adults show that they desire for more time to discuss their health problems with their Family doctors.
The research evidence also shows that Family doctors feel equally frustrated because of lack of time and coordination in the healthcare system. There are also problems with the current clinical practice guidelines used by doctors, because these are typically developed to focus on one disease and are not developed for people with multiple health conditions.
There are new approaches for delivering care to older adults with multiple health problems being evaluated. The IMPACT program is one such approach. Programs like IMPACT aim to assess and manage all the patient concerns. This approach includes a multidisciplinary team (doctor, pharmacist, physiotherapist, social worker, etc.). The team assess and develop a plan together with the patient and their caregiver. This approach allows for adequate time to consider all the health issues. Preliminary research results evaluating the IMPACT approach are very promising. They show increased clinician, caregiver and patient satisfaction.

Patients visiting their doctors often complain that they must restrict what they discuss with them to only one health problem at each visit, which isn’t helpful. In this series of videos, Dr. Ross Upshur discusses some of the challenges faced by patients and physicians, and some of the innovative approaches being explored.

Typical older patients

Frustrated with interactions with providers?

Dealing with only one problem at a time

New initiatives to help

Complex needs

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Author Details

Ross Upshur

Ross Upshur is currently the Scientific Director, Bridgepoint Collaboratory for Research and Innovation and Head of the Division of Clinical Public Health at the University of Toronto Dalla Lana School of Public Health. Dr. Upshur is the Canada Research Chair in Primary Care Research. At the University of Toronto he is a Professor at the Department of Family and Community Medicine and Dalla Lana School of Public Health, Adjunct Scientist at the Institute of Clinical Evaluative Sciences, an affiliate of the Institute of the History and Philosophy of Science and Technology and a member of the Centre for Environment. He is an Adjunct Associate Professor in the School of Geography and Earth Sciences and Associate Member of the Institute of Environment and Health at McMaster University.

References

Bajcar JM, Wang L, Moineddin R, Nie JX, Tracy CS, Upshur RE. From pharmaco-therapy to pharmaco-prevention: trends in prescribing to older adults in Ontario, Canada, 1997-2006. BMC Fam Pract 2010;11:75.
Ekdahl AW, Hellstrom I, Andersson L, Friedrichsen M. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012;2(3).
Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP. "Where do we go from here?" health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthc Policy 2014 May;9(4):73-89.
Kuluski K, Gill A, Naganathan G, Upshur R, Jaakkimainen RL, Wodchis WP. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. BMC Fam Pract 2013;14:133.
Kuluski K, Gill A, Naganathan G, Upshur R, Jaakkimainen RL, Wodchis WP. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. BMC Fam Pract 2013;14:133.
Mutasingwa DR, Ge H, Upshur RE. How applicable are clinical practice guidelines to elderly patients with comorbidities? Can Fam Physician 2011 Jul;57(7):e253-e262.
Nie JX, Wang L, Tracy CS, Moineddin R, Upshur RE. A population-based cohort study of ambulatory care service utilization among older adults. J Eval Clin Pract 2010 Aug;16(4):825-31.
Parekh AK, Kronick R, Tavenner M. Optimizing Health for Persons With Multiple Chronic Conditions. JAMA 2014 Aug 18.
Sinnott C, Mc HS, Browne J, Bradley C. GPs' perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open 2013;3(9):e003610.
Tracy CS, Bell SH, Nickell LA, Charles J, Upshur RE. The IMPACT clinic: innovative model of interprofessional primary care for elderly patients with complex health care needs. Can Fam Physician 2013 Mar;59(3):e148-e155.
Upshur RE, Tracy S. Chronicity and complexity: is what's good for the diseases always good for the patients? Can Fam Physician 2008 Dec;54(12):1655-8.
Upshur RE. Do clinical guidelines still make sense? No. Ann Fam Med 2014 May;12(3):202-3.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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