Nurse Practitioners Can Help Boost Quality of Care for Older Patients with Chronic Conditions
residents today are living longer than previous generations, thanks to improved public health and medical treatment. But they’re also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care. Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions. Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments. One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings? The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study’s findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions. “It is becoming increasingly clear that care of chronic geriatric conditions is better when it’s done in teams,” said the study’s lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA. “There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners.” Reuben noted while doctors are generally good at treating acute medical conditions and those requiring highly complex decisionmaking, some chronic conditions tend to be “swept by the wayside” because physicians either don’t have the time or are simply not as skilled in dealing with them. The study authors found the percentage of quality indicators that were satisfied for patients whose cases were co-managed by a nurse practitioner and a physician 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; for dementia, 59 percent were satisfied, compared with 38 percent; and for depression, 63 percent were satisfied, compared with 60 percent.