Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said doctors are generally good at treating acute medical conditions and those requiring highly complex decision-making.
However, some chronic conditions tend to be "swept by the wayside" because physicians either don't have the time or are not as skilled in dealing with them.
The researchers 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 patients were then randomly selected for medical review.
The study, published in the Journal of the American Geriatrics Society, found the percentage of quality indicators that were satisfied for patients whose cases were co-managed by a nurse practitioner and a physician -- co-managed cases -- was higher than for those seen only by a physician.
For falls, 80 percent of quality indicators were satisfied for co-managed cases, compared with 34 percent for physicians alone; for urinary incontinence, 66 percent of indicators were satisfied, compared with 19 percent with doctors alone; for dementia, 59 percent were satisfied, compared with 38 percent; and for depression, 63 percent were satisfied, compared with 60 percent, the study found
Much of the difference was due to the fact that the nurses were likely to take far more detailed patient histories and to perform other assessments. For instance, 91 percent of the co-managed cases took a patient's history of falls versus 47 percent of the doctor, vision testing was 87 percent, versus 36 percent; and discussion of treatment options for urinary incontinence was 79 percent, versus 28 percent.
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