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. 2021 Feb;69(2):432-440. doi: 10.1111/jgs.16945. Epub 2020 Nov 20.
To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care.
Cross-sectional, national mail-based survey.
American Medical Association Masterfile database.
U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62).
Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments.
Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type.
Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.
描述初级保健中评估和处理家庭照顾者需求和风险的当前实践、障碍和促进因素。
横断面、全国邮件为基础的调查。
美国医学协会主文件数据库。
美国初级保健医生（N=106），包括普通内科医生（n=44）和老年病医生（n=62）。
评估和处理家庭照顾者需求和风险的方法；进行照顾者评估的障碍和促进因素。
很少有受访者报告在过去一年中使用标准化工具进行正式照顾者评估（10.5%）。关于照顾者需求和风险的非正式、非结构化讨论很常见，涵盖了一系列问题，最常见的是照顾者对患者安全的管理（41.0%）、提供帮助的能力（40.0%）和对支持的需求（40.0%）。为了解决照顾者的需求，大多数受访者支持将患者转介到服务机构（如成人日间护理、家庭护理）（69.8%）、评估患者生活环境的适宜性（67.9%）和将照顾者转介到社区机构（63.2%）。缺乏时间是评估照顾者需求时最常被提到的障碍（81.1%）。最常被认可的促进因素是获得更好的转介选择（67.0%）和更容易的转介机制（65.1%）。医生类型对照顾者评估的实践模式、障碍和促进因素没有影响。
初级保健医生使用非正式、非结构化的讨论而不是标准化工具来评估照顾者的需求和风险。讨论的主题和转介的类型存在差异。研究结果表明，从研究到实践，照顾者评估工具的翻译缺乏。
