Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.
Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2020 Jun;68(6):1262-1270. doi: 10.1111/jgs.16401. Epub 2020 Mar 13.
To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care.
Qualitative study consisting of in-depth semi-structured interviews.
Four primary care practices located in urban and rural settings.
Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling.
Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio-recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis.
Participating clinicians had been in practice for an average of 12.8 years (range = 1-36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregivers' needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician-caregiver communication, and validate caregivers' efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self-administered assessment tools and post-screen discussions with practice staff.
Identification of caregivers' needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262-1270, 2020.
了解在初级保健中系统评估家庭照顾者需求和风险的当前实践、挑战和机遇。
由深入的半结构化访谈组成的定性研究。
位于城市和农村环境中的四个初级保健实践。
初级保健临床医生、工作人员和管理人员（N=30），以及老年患者和家庭照顾者（N=40），通过目的性和最大变异抽样招募。
将标准化照顾者评估纳入初级保健提供的当前经验、挑战和机遇。采访进行了录音和转录；使用数据分析的恒定性比较方法对转录本进行了分析。
参与的临床医生的平均从业时间为 12.8 年（范围=1-36 年）。患者的平均年龄为 84.0 岁（标准差[SD]=9.7）；照顾者的平均年龄为 67.0 岁（SD=9.3）。在识别照顾者的需求和风险方面，当前的实践方法差异很大，包括直接和间接的方法，在考虑到这些问题时。参与者认为，将标准化照顾者评估纳入初级保健提供可以帮助改善患者护理，增强临床医生与照顾者之间的沟通，并验证照顾者的努力。评估的障碍包括时间和报销不足、责任问题、对社区资源缺乏认识以及对患者自主权的担忧。为了促进未来对照顾者评估的采用，参与者建议使用简短的自我管理评估工具和与实践工作人员进行的后续筛选讨论。
在初级保健中识别照顾者的需求和风险具有高度的可变性。将标准化照顾者评估纳入实践需要政策的协调变化、实践工作流程的修订以及跨学科方法来开发适当的评估工具。美国老年学会杂志 68:1262-1270，2020 年。
