Geriatric Medicine Training and Practice in the United States at the ...

Figure 4.4 American Geriatric Society (AGS) and American Medical
Directors Association (AMDA) Membership Trends 1976-2001
10,000
8,000
6,000
4,000
6,371
5,930
4,675
4,952
2,000
1,641
60 240 500
675
0 1976 1980 1984 1988 1992 1996 2000 2001 2002
short-term basis, but they rarely translate into long-term changes in
physician performance (Robinson, Barry, & Renick et al., 2001).
Physician Confidence in Learning More
about Common Geriatrics Topics
In a 1998 study, primary care physicians were surveyed to assess
their confidence in treating older patients and their interest in learning
more about geriatric medicine topics. A convenience sample of family
physicians and internists attending the annual AAFP and ACP meetings
were chosen for the study. The survey sample participants had
graduated from medical school a mean of 16 years previously.
Physicians with more years of clinical experience and with a higher
percentage of older patients in their practices had more confidence
in their abilities in geriatrics. Most of the physicians surveyed were
interested in learning more about the topics of dementia, functional
assessment, urinary incontinence, and sensory impairment (Robinson,
Barry, & Renick et al., 2001).
Enhancing Geriatric Care Through
Practicing Physician Education (PPE)
Recognizing a need to more effectively educate community-based
primary care physicians about the special health care needs of older
adults, several foundations and corporations have supported various
educational initiatives over the past five years. The John A. Hartford
Foundation of New York is funding a special project titled Enhancing
Geriatric Care through Practicing Physician Education to develop,
implement, evaluate, and disseminate optimal ways to spread
geriatrics knowledge and to enhance the skills of community-based
primary care physicians. The project began with a one-year planning
grant (12/96-12/97) to the AGS. That grant resulted in development of
a coordinated strategic approach to address the geriatric educational
needs of practicing primary care physicians, taking into account the
current health care environment. The outcome was a pair of
AGS
6,118
AMDA
8,766
8,834
6,155
5,785
5,920
5,359
Source: AGS, 2002 (Personal communication, Deirdre Terry, AGS) & AMDA, 2002
(Personal communication, Lorraine Tarnove, AMDA)
7,032
innovative models, the Physician Leader Model and the
Opinion Leader Model, for practicing physician education in
geriatrics. In 1998 the John A. Hartford Foundation awarded
the AGS a four-year, $1.9 million grant to develop,
implement, evaluate, and disseminate both models. These
models employ different approaches to apply the most
up-to-date knowledge and use adult learning strategies for
teaching evidence-based medicine directed at the areas of
physician education and performance change. Sharon
Levine, MD, and Bruce E. Robinson, MD, are the current
project co-directors.
In developing the Physician Leader Model, the AGS
collaborated with the American College of Physicians-
American Society of Internal Medicine (ACP-ASIM) and the
American Academy of Family Physicians (AAFP) to identify
and train physicians who, in turn, are expected to conduct
geriatric educational sessions with primary care physicians
in their communities. Five physician leader model training
sessions were conducted at the annual meetings of the
ACP-ASIM and the AAFP, with fifty participants subsequently
returning to their communities to facilitate small-group,
two-hour educational sessions with their peers. A sixth and final
training session took place at the AAFP’s national meeting in October
2001. Preliminary data indicate that trainees had conducted 64
community sessions by December 2000, with a total of 553
community doctors participating. The results of this program are still
being studied.
In promoting the Opinion Leader Model, the AGS identified and
trained opinion leaders (influential physicians in selected communities)
to provide leadership for physicians, health care teams, the public,
and policy makers to enhance the quality of care provided to geriatric
patients. Two communities, Sarasota, Florida, and Stamford,
Connecticut, have participated in the Opinion Leader Model, focusing
on improving physician early identification of memory loss. After
completing their first year of work, physicians in the Stamford Opinion
Leader Program chose to extend their participation for a second year.
In-depth evaluations are now underway to learn more about the
participating physicians’ experiences in both communities, and to
apply “lessons learned” to those who wish to replicate the model at
their own sites.
Assessing Care of Vulnerable Elders
(The ACOVE Project)
The ACOVE project is developing and testing the use of evidencebased
indicators of the quality of care being provided to older adults.
The project began in 1998 and is based at UCLA/RAND. It receives
funding from Pfizer, Inc. Neil Wenger, MD, and Paul Shekelle, MD, PhD,
are the co-project directors. The project is guided by a Policy Advisory
Committee, chaired by Phillip Lee, MD.
ACOVE’s first-phase goal was to develop and test a system to
evaluate the quality of healthcare received by community-dwelling
older adults. The resultant measurement system is based on evidence
in the medical literature and the clinical expertise of an independent
panel of experts. An advisory panel of geriatrics experts identified 22
clinical conditions for which effective treatments exist and which the
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