March 28, 2018

‘Hide and seek’ a barrier to GPs visiting residential aged care facilities

Doctors enjoy providing care for aged-care facility patients but frustrated by system deficiencies

A study by University of Wollongong (UOW) researchers has found that while general practitioners enjoy visiting patients in residential aged care facilities (RACFs), they also find it frustrating due to avoidable delays and inefficiencies.

The number of older Australians living in RACFs will grow from 270,000 in 2013-2014 to 700,000 by 2050, according to forecasters. Many of the residents of aged care facilities have complex health care needs, presenting a major challenge for the GPs who look after them.

While the RACF population is growing rapidly, the number of GPs providing care in these facilities may be declining.

Lead investigator Dr Russell Pearson, a Clinical Associate Professor at UOW’s School of Medicine and a practising GP, said it was vital to understand GP attitudes towards RACF visits in order to identify and resolve inefficiencies and ensure the continuation of GPs providing care in those facilities.

“In 2013 I saw an advertisement for practices looking for GPs which mentioned no nursing home visiting as an incentive to joining the practice and I was astonished! It made me wonder had the people writing the ads accurately captured the mood of Australian GPs?” Dr Pearson (pictured above with fellow researcher Ms Bridget Dijkmans-Hadley) said.

“So we searched the literature which suggested that the sustainability of the Australian general practice RACF workforce is under threat. Only about 50 per cent of Australian GPs currently visit RACFs but there is a heavy reliance on older male GPs. Only 40 per cent of early career GPs visit nursing homes.

“This research identified barriers to GP participation in RACF visiting which were managerial rather than attitudinal.”

The researchers spoke with GPs and GP Registrars working in rural and regional NSW, using focus group discussions and one-on-one interviews. They found that GPs generally enjoyed caring for patients in nursing homes, and felt it to be an integral part of general practice.

“It’s part of your duty of care to look after them,” said one participant.

“We should be looking after our elderly well and with kindness and good treatment,” said another.

However, the study also revealed that many GPs found visiting RACFs a frustrating experience.

“The overwhelming finding was the frustration that engaged GPs experienced in their visits. For many GPs, the experience of visiting RACFs was one of hide and seek: seeking out the patient, the nurse, their notes and medication charts,” Dr Pearson said.

Added to this frustration was the belief that this work was poorly remunerated relative to the work they undertook at their surgery.

“GPs felt they were financially disadvantaged by their commitment to visiting RACFs,” Dr Pearson said.

“Younger GPs were hesitant about engaging in this work because many were inexperienced or educationally unprepared because of the lack of RACF visiting during their training. Nevertheless the GPs enjoyed the work and felt a sense of duty to continue the care of this frail and vulnerable group.”

Dr Pearson said better communication between general practice managers and RACF management to improve logistical support and reduce bureaucratic barriers was one way to improve the experience for both GPs and their patients.

“Engaging all of the stakeholders – GPs, residents, family and RACF staff – in advanced care planning would help GPs provide more appropriate care according to the residents and families’ wishes. This would reduce the stress on GPs and improve residents care,” he said.

“The obvious criticism of this research is that it’s focussed on the GP perspective. We are now undertaking additional research to include the experience of RACF staff, residents and families and GPs. This next stage of research enables us to have a 360-degree view of the care of this vulnerable population.”

The study, ‘Australian General Practitioner Attitudes to Residential Aged Care Facility Visiting’ by Dr Russell Pearson, Dr Judy Mullan, Dr Eniko Ujvary, Professor Andrew Bonney, and Ms Bridget Dijkmans-Hadley, is published online in the current issue of Health & Social Care in the Community.

The research was undertaken with assistance from the Illawarra and Southern Practice Research Network, and the support of grants from the University of Wollongong Discipline of Graduate Medicine and Coast City Country GP Training P/L.