1
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Scannell GA, Bevan DJ, Cowan A, Weiss RJ, Brenner RJ, Farrell TW, Yarbrough PM, Rupper RW, Eleazer GP. A Clinical Pharmacist-Led Transitions of Care Program for Veterans with Two Planned Care Transitions (Hospital to Skilled Care and Skilled Care to Home) amid the COVID-19 Pandemic. J Am Med Dir Assoc 2024:105006. [PMID: 38679062 DOI: 10.1016/j.jamda.2024.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/01/2024]
Abstract
Transitional care teams have been shown to improve patient safety. We describe a novel transitional care team with a clinical pharmacist as team leader initiated amid the COVID-19 pandemic. The program focused on Veterans with 2 planned transitions of care: hospital to skilled nursing facility (SNF) and from SNF to home. Ninety older Veterans were enrolled, and 79 medication errors and 80 appointment errors were identified. We conclude that a pharmacist-led program can improve safety in patients with 2 planned transitions of care.
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Affiliation(s)
- Gabrielle A Scannell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Salt Lake City, UT, USA.
| | - Darion J Bevan
- Department of Pharmacy, George E. Wahlen VA, Salt Lake City, UT, USA
| | - Amy Cowan
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; Department of Internal Medicine, George E. Wahlen VA, Salt Lake City, UT, USA
| | - Roxanne J Weiss
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Rachel J Brenner
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Salt Lake City, UT, USA
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Salt Lake City, UT, USA
| | - Peter M Yarbrough
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; Department of Internal Medicine, George E. Wahlen VA, Salt Lake City, UT, USA
| | - Randall W Rupper
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Salt Lake City, UT, USA
| | - G Paul Eleazer
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Salt Lake City, UT, USA
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2
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Sinvani L, Karris M, Young ME, Farrell TW. Tideswell Emerging Leaders in Aging Special Interest Group: Cultivating a growing community of Geriatrics leaders. J Am Geriatr Soc 2024; 72:961-964. [PMID: 37929339 DOI: 10.1111/jgs.18666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Liron Sinvani
- Department of Medicine, Zucker School of Medicine at Hofstra University, Northwell Health, Manhasset, New York, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Maile Karris
- Department of Medicine, University of California San Diego (UCSD), San Diego, California, USA
| | - Megan E Young
- Department of Internal Medicine, Section of Geriatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA
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3
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Stephens CE, Utz R, Tay D, Iacob E, Hollingshaus M, Goodwin R, Farrell TW, Bouldin E, Edelman L, Reinke LF, Smith K, Ellington L, Ornstein K. Dying with dementia in nursing homes: A population-based study of decedents and their families. J Am Geriatr Soc 2024. [PMID: 38308399 DOI: 10.1111/jgs.18770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Families play a critical role in end-of-life (EOL) care for nursing home (NH) residents with dementia. Despite the important role of family, little is known about the availability and characteristics of families of persons with dementia who die in NHs. METHODS This is a retrospective cohort study of 18,339 individuals 65 years and older with dementia who died in a Utah NH between 1998 and 2016, linked to their first-degree family (FDF) members (n = 52,566; spouses = 11.3%; children = 58.3%; siblings = 30.3%). Descriptive statistics, chi-square tests, and t-tests were used to describe the study cohort and their FDF members and to compare sociodemographic and death characteristics of NH decedents with (n = 14,398; 78.5%) and without FDF (n = 3941; 21.5%). RESULTS Compared with NH decedents with FDF, NH decedents with dementia without FDF members were more likely to be older (mean age 86.5 vs 85.5), female (70.5% vs 59.3%), non-White/Hispanic (9.9% vs 3.2%), divorced/separated/widowed (84.4% vs 61.1%), less educated (<12th grade; 42.2% vs 33.7%), have Medicare and Medicaid (20.8% vs 12.5%), and die in a rural/frontier NH (25.0% vs 23.4%). NH decedents who did not have FDF were also more likely to die from cancer (4.2% vs 3.9%), chronic obstructive pulmonary disease (COPD; 3.9% vs 2.5%), and dementia (40.5% vs 38.4%) and were less likely to have 2+ inpatient hospitalizations at EOL (13.9% vs 16.2%), compared with NH decedents with FDF. CONCLUSIONS Findings highlight differences in social determinants of health (e.g., sex, race, marital status, education, insurance, rurality) between NH decedents with dementia who do and do not have FDF-factors that may influence equity in EOL care. Understanding the role of family availability and familial characteristics on EOL care outcomes for NH residents with dementia is an important next step to informing NH dementia care interventions and health policies.
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Affiliation(s)
| | - Rebecca Utz
- Sociology Department, University of Utah, Salt Lake City, Utah, USA
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Rebecca Goodwin
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA
| | - Erin Bouldin
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Linda Edelman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lynn F Reinke
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Ken Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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4
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Rigby JH, Canham SL, Farrell TW, Zeljkovic A, Hobson WL. Student Preferences for Virtual or In-Person Interprofessional Education Simulations. J Allied Health 2024; 53:e55-e59. [PMID: 38430505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 03/03/2024]
Abstract
The COVID-19 pandemic created a shift in interprofessional education (IPE) courses, causing programs to change pedagogical approaches. We sought to examine student preferences for taking IPE simulations. On post-simulation surveys from two courses (n=844 students, 2020-2022 academic years), we asked students if they preferred to take the simulation through a synchronous in-person or virtual format. More students preferred a virtual platform in academic year 2021-2022 than the previous year (p<0.001). Students who chose the virtual format believed it was more convenient, reduced COVID-19 transmission, and eased interprofessional collaboration. The downsides to in-person simulations included travel logistics and technical challenges in the simulation lab. Students suggested that in-person simulations more closely resembled 'real life' and that communication and body language are easier to convey in person.
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Affiliation(s)
- Justin H Rigby
- College of Health, University of Utah, 290 S 1850 E, HPER-West Rm. 113, Salt Lake City, UT 84112, USA. Tel 801-213-1315.
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5
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Dukhanin V, Wolff JL, Salmi L, Harcourt K, Wachenheim D, Byock I, Gonzales MJ, Niehus D, Parshley M, Reay C, Epstein S, Mohile S, Farrell TW, Supiano MA, Jajodia A, DesRoches CM. Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement. J Med Internet Res 2023; 25:e46146. [PMID: 37991827 PMCID: PMC10701652 DOI: 10.2196/46146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends-"care partners"-to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. OBJECTIVE We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. METHODS In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. RESULTS Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan "People remember less than half of what their doctors say," which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. CONCLUSIONS Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Liz Salmi
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Kendall Harcourt
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deborah Wachenheim
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ira Byock
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Matthew J Gonzales
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Doug Niehus
- Providence Medical Group, Portland, OR, United States
| | | | - Caroline Reay
- Providence Medical Group, Portland, OR, United States
| | - Sara Epstein
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Supriya Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
- Salt Lake City Geriatric Research, Education, and Clinical Center, Veterans Affairs, Salt Lake City, UT, United States
| | - Mark A Supiano
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - Anushka Jajodia
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine M DesRoches
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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6
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Farrell TW. Ageism as a barrier to eliciting what matters: A call for multigenerational action to confront the invisible "-ism". J Am Geriatr Soc 2023; 71:3024-3027. [PMID: 37596701 DOI: 10.1111/jgs.18551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Abstract
This editorial comments on the article by Sun et al. in this issue.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA
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7
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Farrell TW, Greer AG, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. Acad Med 2023; 98:563-568. [PMID: 36255204 DOI: 10.1097/acm.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.
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Affiliation(s)
- Timothy W Farrell
- T.W. Farrell is professor of medicine and associate chief for age-friendly care, Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, and physician investigator, VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0003-0070-8757
| | - Annette G Greer
- A.G. Greer is associate professor and vice chair of diversity, equity, and inclusion, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ORCID: https://orcid.org/0000-0002-2868-0306
| | - Scott Bennie
- S. Bennie is dean of academic affairs, Kettering College, Kettering, Ohio; ORCID: https://orcid.org/0000-0001-7601-452X
| | - Heather Hageman
- H. Hageman is director, Center for Interprofessional Practice and Education, Washington University Medical Center, a collaboration between Goldfarb School of Nursing at Barnes-Jewish College, the University of Health Sciences and Pharmacy in St Louis, and Washington University School of Medicine, St Louis, Missouri
| | - Andrea Pfeifle
- A. Pfeifle is professor of family and community medicine and associate vice chancellor for interprofessional practice and education, The Ohio State University and Wexner Medical Center, Columbus, Ohio
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8
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Brenner R, Cole L, Towsley GL, Farrell TW. Adults Without Advocates and the Unrepresented: A Narrative Review of Terminology and Settings. Gerontol Geriatr Med 2023; 9:23337214221142936. [PMID: 36726410 PMCID: PMC9884943 DOI: 10.1177/23337214221142936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 01/26/2023] Open
Abstract
Socially isolated adults, including those with and without the ability to make medical decisions, are encountered in clinical practice and are at risk for adverse health outcomes. Consensus is lacking on appropriate terminology to describe subpopulations of these patients. In addition, little is known about the settings in which they present. These gaps prevent clinicians and policymakers from identifying and understanding these populations and deploying appropriate resources to meet their complex needs. We conducted a narrative review of literature on socially isolated adults aged 50 and older to assess and integrate the available evidence regarding the terminology used to describe unrepresented patients and adults without advocates to inform consensus on terminology. We also identified the settings in which unrepresented patients and adults without advocates are described in the literature, including both within and outside health care settings. Our results indicate that there is heterogeneity and inconsistency in the terminology used to describe socially isolated adults, as well as heterogeneity in the settings in which they are identified in the literature. Our findings suggest that future work should include achieving consensus on terminology and integrating proactive interdisciplinary interventions across health systems and communities to prevent adults without advocates from becoming unrepresented.
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Affiliation(s)
- Rachel Brenner
- VA Salt Lake City Geriatric Research,
Education, and Clinical Center,Spencer Fox Eccles School of Medicine
at the University of Utah, Salt Lake City, USA,Rachel Brenner, Division of Geriatrics,
Spencer Fox Eccles School of Medicine, University of Utah, 500 Foothill Dr, Mail
Code 182H, Salt Lake City, UT 84148, USA.
| | - Linda Cole
- University of Utah College of Nursing,
Salt Lake City, USA
| | | | - Timothy W. Farrell
- Spencer Fox Eccles School of Medicine
at the University of Utah, Salt Lake City, USA
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9
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Farrell TW, Volden TA, Butler JM, Eleazer GP, Rupper RW, Echt KV, Shaughnessy M, Supiano MA. Cover. J Am Geriatr Soc 2023. [DOI: 10.1111/jgs.17233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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10
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Farrell TW, Volden TA, Butler JM, Eleazer GP, Rupper RW, Echt KV, Shaughnessy M, Supiano MA. Age-friendly care in the Veterans Health Administration: Past, present, and future. J Am Geriatr Soc 2023; 71:18-25. [PMID: 36254360 DOI: 10.1111/jgs.18070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure. These innovative care models also contributed to the evidence base supporting the present-day Age-Friendly Health Systems movement, with which VHA is inherently aligned. As both a provider of and payor for care, VHA is strongly incentivized to promote coordination across the continuum of care, with resultant cost savings. VHA is also a major contributor to developing the workforce that is essential for the provision of age-friendly care. As VHA continues to develop and refine innovative geriatric models of care, policymakers and non-VHA health care systems should look to VHA programs as exemplars for the development and implementation of age-friendly care.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Tiffany A Volden
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Jorie M Butler
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Biomedical Informatics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - G Paul Eleazer
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Randall W Rupper
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Katharina V Echt
- VA Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA and Decatur, Georgia, USA.,Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marianne Shaughnessy
- Office of Geriatrics and Extended Care, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Mark A Supiano
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
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11
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Farrell TW, Hung WW, Unroe KT, Brown TR, Furman CD, Jih J, Karani R, Mulhausen P, Nápoles AM, Nnodim JO, Upchurch G, Whittaker CF, Kim A, Lundebjerg NE, Rhodes RL. Cover. J Am Geriatr Soc 2022. [DOI: 10.1111/jgs.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Farrell TW, Hung WW, Unroe KT, Brown TR, Furman CD, Jih J, Karani R, Mulhausen P, Nápoles AM, Nnodim JO, Upchurch G, Whittaker CF, Kim A, Lundebjerg NE, Rhodes RL. Exploring the intersection of structural racism and ageism in healthcare. J Am Geriatr Soc 2022; 70:3366-3377. [PMID: 36260413 PMCID: PMC9886231 DOI: 10.1111/jgs.18105] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 02/01/2023]
Abstract
The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well-documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.
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Affiliation(s)
- Timothy W. Farrell
- Division of Geriatrics, Spencer Fox Eccles School of
Medicine, University of Utah, Salt Lake City, Utah, USA
- VA Salt Lake City Geriatric Research, Education, and
Clinical Center, Salt Lake City, Utah, USA
| | - William W. Hung
- Department of Geriatrics and Palliative Medicine, Icahn
School of Medicine at Mount Sinai, New York New York, USA
- Geriatric Research, Education and Clinical Center, James J
Peters VA Medical Center, New York New York, USA
| | - Kathleen T. Unroe
- Department of Medicine, Indiana University, Indianapolis,
Indiana, USA
- Regenstrief Institute, Indiana University Center for Aging
Research Indianapolis, Indianapolis, Indiana, USA
| | - Teneille R. Brown
- Center for Law and Biomedical Sciences, University of Utah
S.J. Quinney College of Law, Salt Lake City, Utah, USA
| | - Christian D. Furman
- Department of Geriatric Medicine, Department of Geriatric
and Palliative Medicine, Trager Institute/Optimal Aging Clinic, University of
Louisville, Louisville, Kentucky, USA
| | - Jane Jih
- Division of General Internal Medicine, Multiethnic Health
Equity Research Center, Asian American Research Center on Health, University of
California, San Francisco, San Francisco, California, USA
| | - Reena Karani
- Department of Medical Education, Department of Medicine,
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine
at Mount Sinai, New York New York, USA
| | | | - Anna María Nápoles
- Division of Intramural Research, National Institute on
Minority Health and Health Disparities, National Institutes of Health, Bethesda,
Maryland, USA
| | - Joseph O. Nnodim
- Division of Geriatric and Palliative Medicine, Department
of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gina Upchurch
- Senior PharmAssist, Durham, North Carolina, USA
- Eshelman School of Pharmacy, Department of Public Health
Leadership, Gillings School of Global Public Health, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chanel F. Whittaker
- Department of Practice, Sciences, and Health Outcomes
Research (P-SHOR), The Peter Lamy Center on Drug Therapy and Aging, University of
Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Anna Kim
- American Geriatrics Society, New York New York, USA
| | | | - Ramona L. Rhodes
- Central Arkansas Veterans Healthcare System, Geriatric
Research Education and Clinical Center, North Little Rock, Arkansas, USA
- Department of Geriatrics, University of Arkansas for
Medical Sciences, Little Rock, Arkansas, USA
- Division of Geriatric Medicine, University of Texas
Southwestern Medical Center, Dallas, Texas, USA
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13
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Farrell TW, Butler JM, Towsley GL, Telonidis JS, Supiano KP, Stephens CE, Nelson NM, May AL, Edelman LS. Communication Disparities between Nursing Home Team Members. Int J Environ Res Public Health 2022; 19:5975. [PMID: 35627513 PMCID: PMC9141434 DOI: 10.3390/ijerph19105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Optimal care in nursing home (NH) settings requires effective team communication. Certified nursing assistants (CNAs) interact with nursing home residents frequently, but the extent to which CNAs feel their input is valued by other team members is not known. We conducted a cross-sectional study in which we administered a communication survey within 20 Utah nursing home facilities to 650 team members, including 124 nurses and 264 CNAs. Respondents used a 4-point scale to indicate the extent to which their input is valued by other team members when reporting their concerns about nursing home residents. We used a one-way ANOVA with a Bonferroni correction. When compared to nurses, CNAs felt less valued (CNA mean = 2.14, nurse mean = 3.24; p < 0.001) when reporting to physicians, and less valued (CNA mean = 1.66, nurse mean = 2.71; p < 0.001) when reporting to pharmacists. CNAs did not feel less valued than nurses (CNA mean = 3.43, nurse mean = 3.37; p = 0.25) when reporting to other nurses. Our findings demonstrate that CNAs feel their input is not valued outside of nursing, which could impact resident care. Additional research is needed to understand the reasons for this perception and to design educational interventions to improve the culture of communication in nursing home settings.
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Affiliation(s)
- Timothy W. Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, AB 193 SOM, Salt Lake City, UT 84132, USA;
- Geriatric Research, Education, and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Jorie M. Butler
- Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, AB 193 SOM, Salt Lake City, UT 84132, USA;
- Geriatric Research, Education, and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
| | - Jacqueline S. Telonidis
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
| | - Katherine P. Supiano
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
| | - Caroline E. Stephens
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
| | - Nancy M. Nelson
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
| | - Alisyn L. May
- College of Pharmacy, University of Utah, 30 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Linda S. Edelman
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; (G.L.T.); (J.S.T.); (K.P.S.); (C.E.S.); (N.M.N.); (L.S.E.)
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14
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Varela AE, Rodriguez JE, Farrell TW. Oral health is an integral component of age-friendly care. J Am Geriatr Soc 2022; 70:2442-2444. [PMID: 35535666 DOI: 10.1111/jgs.17834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Enrique Varela
- Section of Geriatric and Adult Special Care Dentistry, University of Utah School of Dentistry, Salt Lake City, Utah, USA
| | - Jose E Rodriguez
- Office of the Associate Vice-President for Health Equity, Diversity, and Inclusion, University of Utah Health, Salt Lake City, Utah, USA
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
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15
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Farrell TW, Towsley GL, Eaton J, Butler JM, Supiano KP, Stephens C, Witt C, Nelson NM, Edelman LS. The Development and Validation of a Communication Survey Instrument for Long-term Care Staff. J Contin Educ Nurs 2022; 53:123-130. [PMID: 35244460 DOI: 10.3928/00220124-20220210-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Information transfers in long-term care (LTC) settings between and among providers, staff, residents, and family caregivers are often fragmented. In order to identify training needs to improve communication, a survey instrument was developed and refined to assess the self-efficacy of LTC staff in communicating with staff, providers, residents, and caregivers. This 11-item survey instrument, based on a literature review, covered four key concepts (mutual respect, recognizing and responding to sensory deficits, limited health literacy, and changes in condition) relevant to communicating health information in LTC settings. Ten content experts evaluated each survey item using a 4-point scale. The content validity of the survey was established by using the content validity index to assess results at the item and scale levels. All items scored 0.90 or greater and were retained. Future work should entail broad-scale validation and testing of this survey across the United States. By assessing the self-efficacy of LTC staff in communicating with the interprofessional team, leadership teams can design personalized interprofessional continuing education activities aimed at improving communication skills. [J Contin Educ Nurs. 2022;53(3):123-130.].
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16
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Neuberger K, McCrary H, Beckstrom J, Darelli‐Anderson AM, Farrell TW, Brooke BS, Smith BK, Brownson KE. Improving healthcare transitions of surgical care through an
interprofessional
education elective. J Am Geriatr Soc 2022; 70:E11-E14. [DOI: 10.1111/jgs.17670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kaden Neuberger
- University of Utah School of Medicine Salt Lake City Utah USA
| | - Hilary McCrary
- Division of Otolaryngology – Head and Neck Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | - Julie Beckstrom
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | | | - Timothy W. Farrell
- Division of Geriatrics University of Utah School of Medicine Salt Lake City Utah USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center Salt Lake City Utah USA
- University of Utah Health Interprofessional Education Program Salt Lake City Utah USA
| | - Benjamin S. Brooke
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
| | - Brigitte K. Smith
- Division of Vascular Surgery University of Utah School of Medicine Salt Lake City Utah USA
- Office of Surgical Education University of Utah School of Medicine Salt Lake City Utah USA
| | - Kirstyn E. Brownson
- Division of General Surgery University of Utah School of Medicine Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
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17
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Bennie S, Greer AG, Farrell TW, Hageman H, Pfeifle AL. The Slow Creep Back: Threats and Opportunities for IPE Posed by COVID-19. J Allied Health 2022; 51:9-14. [PMID: 35239754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/30/2021] [Indexed: 06/14/2023]
Abstract
Interprofessional education (IPE) prepares current and future health care professionals for interprofessional collaborative practice (IPCP). IPCP results in increased quality of care demanded by patients and reimbursed in value-based care models when appropriately operationalized. The COVID-19 pandemic forced rapid and unprecedented changes in higher education and healthcare, although the impact on IPE delivery in the U.S. is unknown. Analyses of qualitative survey data collected from U.S. IPE leaders (n = 21) identified the impact and challenges of the pandemic on IPE programs. Three primary themes emerged: transition to a virtual environment, uncertainties and fears regarding finance and program sustainability, and opportunities for improvements in programming, delivery, instructional design, experiential learning, and assessment. Programs faced existential pandemic-related challenges. Concurrently, the pandemic accelerated innovation in IPE curricula, illuminated opportunities for IPE to improve the work life of healthcare providers, and raised awareness of the need to extend the Quadruple Aim to eliminate health inequities.
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Affiliation(s)
- Scott Bennie
- Kettering College, 3737 Southern Blvd., Dayton, OH 45429, USA. Tel 937-395-8718.
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18
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Major AB, Naik AD, Farrell TW. Finding a Voice for the Accidentally Unbefriended. JAMA Intern Med 2021; 181:1159-1160. [PMID: 34228048 DOI: 10.1001/jamainternmed.2021.2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anita B Major
- Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.,House Call Program, Ben Taub General Hospital, Harris Health System, Houston, Texas
| | - Aanand D Naik
- Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah
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19
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Dassel KB, Edelman LS, Moye J, Catlin C, Farrell TW. "I worry about this patient EVERY day": Geriatrics Clinicians' Challenges in Caring for Unrepresented Older Adults. J Appl Gerontol 2021; 41:1167-1174. [PMID: 34463148 DOI: 10.1177/07334648211041261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Unrepresented older adults are at risk for adverse outcomes, and clinicians who care for them may face ethical dilemmas and unique challenges when making person-centered care recommendations. However, little is known about their perspectives on clinical challenges in caring for this population. An online survey was used to assess issues around providing care for unrepresented patients. Ninety-two American Geriatrics Society members working with older adults in inpatient and/or outpatient settings completed the survey. Descriptive qualitative analysis of narrative survey responses identified five broad themes: (a) health risk characteristics of patients, (b) care decisions facing the team, (c) psychosocial considerations by the team, (d) patient outcomes, and (e) burden of the provider and/or health system. These findings demonstrate that geriatrics clinicians face challenges in working with unrepresented adults in both inpatient and outpatient settings. We interpret these results in light of existing literature and propose collaborative approaches that may improve outcomes.
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Affiliation(s)
| | | | - Jennifer Moye
- Boston VA Research Institute, Inc., MA, USA
- VA New England Geriatric Research Education and Clinical Center, Boston, MA, USA
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Timothy W Farrell
- University of UT, Salt Lake City, USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center
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20
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Abstract
Objectives: Unbefriended older adults are those who lack the capacity to make medical decisions and do not have a completed advance directive that can guide treatment decisions or a surrogate decision maker. Adult orphans are those who retain medical decision-making capacity but are at risk of becoming unbefriended due to lack of a completed advance health care directive and lack of a surrogate decision maker. In a follow-up to the 2016 American Geriatrics Society (AGS) position statement on unbefriended older adults, we examined clinicians' experiences in caring for unbefriended older adults and adult orphans.Methods: Clinicians recruited through the AGS (N = 122) completed an online survey about their experiences with unbefriended older adults regarding the perceived frequency of contact, clinical concerns, practice strategies, and terminology; and also with adult orphans regarding the perceived frequency of contact, methods of identification, and terminology.Results: Almost all inpatient (95.9%) and outpatient (86.4%) clinicians in this sample encounter unbefriended older adults at least quarterly and 92.2% of outpatient clinicians encounter adult orphans at least quarterly. Concerns about safety (95.9%), medication self-management (90.4%), and advance care planning (86.3%) bring unbefriended older adults to outpatient clinicians' attention "sometimes" to "frequently." Prolonged hospital stays (87.7%) and delays in transitioning to end-of-life care (85.7%) bring unbefriended older adults to inpatient clinicians' attention "sometimes" to "frequently." Clinicians apply a wide range of practice strategies to these populations. Participants suggested alternative terminology to replace "unbefriended" and "adult orphan."Conclusions: This study suggests that unbefriended older adults are frequently encountered in geriatrics practice, both in the inpatient and outpatient settings, and that there is widespread awareness of adult orphans in the outpatient setting. Clinicians' awareness of both groups suggests avenues for intervention and prevention.Clinical Implications: Health care professionals in geriatric settings will likely encounter older adults in need of advocates. Clinicians, attorneys, and policymakers should collaborate to improve early detection and to meet the needs of this vulnerable population.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT, USA.,University of Utah Health Interprofessional Education Program, Salt Lake City, UT, USA
| | - Casey Catlin
- Boston VA Research Institute, Inc, Boston, MA, USA
| | - Anna H Chodos
- Division of Geriatrics, UCSF Department of Medicine, San Francisco, CA, USA
| | - Aanand D Naik
- Houston Center for Innovations in Quality, Safety, and Effectiveness (IQuESt) at the Michael DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Eric Widera
- Division of Geriatrics, UCSF Department of Medicine, San Francisco, CA, USA
| | - Jennifer Moye
- VA New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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21
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Farrell TW, Francis L, Lundebjerg NE. The Later Innings of Life: Implications of COVID-19 Resource Allocation Strategies for Older Adults. J Am Geriatr Soc 2020; 68:2714-2715. [PMID: 33038008 PMCID: PMC7675312 DOI: 10.1111/jgs.16893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA
| | - Leslie Francis
- S.J. Quinney College of Law, University of Utah, Salt Lake City, Utah, USA.,Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
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22
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Hart SE, Turner K, Farrell TW. An Interprofessional Community-Based Complex Care Course Grounded in Social Determinants of Health. J Am Geriatr Soc 2020; 69:E6-E8. [PMID: 33079385 DOI: 10.1111/jgs.16884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sara E Hart
- Division of Health Systems and Community-Based Care, University of Utah College of Nursing, Salt Lake City, Utah
| | - Kyle Turner
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah.,University of Utah Health Interprofessional Education Program, Salt Lake City, Utah
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23
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Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond. J Am Geriatr Soc 2020; 68:1136-1142. [PMID: 32374440 PMCID: PMC7267615 DOI: 10.1111/jgs.16537] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/14/2023]
Abstract
Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults. This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and deemphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short-term (not long-term) outcomes; (4) avoiding ancillary criteria such as "life-years saved" and "long-term predicted life expectancy" that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID-19, aligning with AGS positions. The statement also includes recommendations for post-pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions. J Am Geriatr Soc 68:1136-1142, 2020.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.,University of Utah Health Interprofessional Education Program, Salt Lake City, Utah, USA
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Teneille Brown
- Center for Law and the Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.,Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leslie Francis
- University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.,Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Ramona Rhodes
- Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.,Central Arkansas Veterans Healthcare System, Geriatric Research, Education, and Clinical Center, Little Rock, Arkansas, USA
| | - Tony Rosen
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Ula Hwang
- Department of Emergency Medicine & Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Leah J Witt
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Division of UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Niranjan Thothala
- Hospitalist Division, Department of Medicine, Good Samaritan Hospital, Vincennes, Indiana, USA.,Hospitalist Division, Department of Medicine, Union Hospital, Terre Haute, Indiana, USA
| | - Shan W Liu
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline A Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA Ann Arbor Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan, USA
| | - Ursula K Braun
- Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Rehabilitation and Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Debra Saliba
- UCLA Borun Center for Gerontological Research, Los Angeles, California, USA.,VA Los Angeles Geriatric Research Education and Clinical Center, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
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24
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Farrell TW, Francis L, Brown T, Ferrante LE, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults. J Am Geriatr Soc 2020; 68:1143-1149. [PMID: 32374466 PMCID: PMC7267288 DOI: 10.1111/jgs.16539] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion that disfavors older adults in resource allocation decisions. This is a companion article to the American Geriatrics Society (AGS) position statement, “Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond.” It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations that should be considered when developing strategies for allocation of scarce resources during an emergency involving older adults. This review presents the legal and ethical background for the position statement and discusses these issues that informed the development of the AGS positions: (1) age as a determining factor, (2) age as a tiebreaker, (3) criteria with a differential impact on older adults, (4) individual choices and advance directives, (5) racial/ethnic disparities and resource allocation, and (6) scoring systems and their impact on older adults. It also considers the role of advance directives as expressions of individual preferences in pandemics. J Am Geriatr Soc 68:1143–1149, 2020. See related paper by Farrell et al.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,VA SLC Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.,University of Utah Health Interprofessional Education Program, Salt Lake City, Utah, USA
| | - Leslie Francis
- University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.,Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
| | - Teneille Brown
- Center for Law and the Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.,Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Ramona Rhodes
- Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.,Central Arkansas Veterans Healthcare System, Geriatric Research, Education, and Clinical Center, Little Rock, Arkansas, USA
| | - Tony Rosen
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Ula Hwang
- Department of Emergency Medicine & Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Leah J Witt
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Division of UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Niranjan Thothala
- Hospitalist Division, Department of Medicine, Good Samaritan Hospital, Vincennes, Indiana, USA.,Hospitalist Division, Department of Medicine, Union Hospital, Terre Haute, Indiana, USA
| | - Shan W Liu
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline A Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA Ann Arbor Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan, USA
| | - Ursula K Braun
- Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Rehabilitation and Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Debra Saliba
- UCLA Borun Center for Gerontological Research, Los Angeles, California, USA.,VA Los Angeles Geriatric Research Education and Clinical Center, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
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Rosenberg LJ, Butler JM, Caprio AJ, Rhodes RL, Braun UK, Vitale CA, Telonidis J, Periyakoil VS, Farrell TW. Results From a Survey of American Geriatrics Society Members' Views on Physician‐Assisted Suicide. J Am Geriatr Soc 2019; 68:23-30. [DOI: 10.1111/jgs.16245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa J. Rosenberg
- Southwest Medical Hospice and Palliative Care Las Vegas Nevada
- Roseman University of Health Sciences Henderson Nevada
| | - Jorie M. Butler
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- Geriatrics Research Education and Clinical Center, IDEAS HSR&D COINVeterans Affairs Medical Center Salt Lake City Utah
| | - Anthony J. Caprio
- Department of Family MedicineAtrium Health Charlotte North Carolina
- Department of Family MedicineUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Ramona L. Rhodes
- Division of Geriatric Medicine, Department of Internal MedicineUT Southwestern Medical Center Dallas Texas
| | - Ursula K. Braun
- Section of Geriatrics, Department of MedicineBaylor College of Medicine Houston Texas
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical Center Houston Texas
| | - Caroline A. Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Ann Arbor Michigan
- Geriatrics Research Education and Clinical CenterVA Ann Arbor Healthcare System Ann Arbor Michigan
| | - Jacqueline Telonidis
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
| | - Vyjeyanthi S. Periyakoil
- Stanford University School of Medicine Stanford California
- VA Palo Alto Health Care System Palo Alto California
| | - Timothy W. Farrell
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- VA Salt Lake City Geriatric Research, Education, and Clinical Center Salt Lake City Utah
- University of Utah Health Interprofessional Education Program Salt Lake City Utah
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26
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Foley KT, Farrell TW, Salzman B, Colburn JL, Kumar C, Rottman-Sagebiel R, Wagner LM, Abrams J, Chang A. Learning to Lead: Reflections from the Tideswell-AGS-ADGAP Emerging Leaders in Aging Program Scholars. J Am Geriatr Soc 2019; 67:434-436. [PMID: 30604862 DOI: 10.1111/jgs.15701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
The Tideswell Emerging Leaders in Aging (ELIA) Program is a 1-year leadership training program focused on developing a sustainable pipeline of leaders in aging who are poised to lead initiatives that will optimize the health of older people. The Tideswell ELIA Program is jointly administered by the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, and Tideswell at University of California, San Francisco (UCSF), a program within the Division of Geriatrics at UCSF. The ELIA Program prepares early to midcareer healthcare professionals in aging (scholars) for their transition into key leadership roles that involve one or more areas of patient care, education, and research. The program emphasizes the understanding of one's own and others' inherent work strategies and communication styles as integral to leading programs. Approximately 15 ELIA scholars are selected annually to participate in this interactive leadership development program. We conducted a qualitative analysis of program evaluations from 2015 to 2018 scholars (n = 47) to determine effectiveness and impact. All scholars (100%) completed the end-of-training survey. Scholars' satisfaction with the program is high. Scholars reported heightened leadership development and improvements in leadership skills, including communication, team building, and self-awareness. Scholars also reported enhancement of personal leadership attributes that contributed to career advancement. The Tideswell ELIA Program accelerates scholars' personal career development, positively impacts their institutions, and ultimately benefits older people. Sustaining leadership programs such as the Tideswell ELIA Program is vital to ensure a continuous pipeline of leaders skilled in both advocating for and advancing the health of older Americans. J Am Geriatr Soc 67:434-436, 2019.
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Affiliation(s)
- Kevin T Foley
- Division of Geriatric Medicine, Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah.,University of Utah Health Interprofessional Education Program, Salt Lake City, Utah
| | - Brooke Salzman
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica L Colburn
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chandrika Kumar
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Rebecca Rottman-Sagebiel
- South Texas Veterans Health Care System, San Antonio, Texas.,Division of Pharmacotherapy, University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education Research Center, University of Texas Health San Antonio, San Antonio, Texas
| | - Laura M Wagner
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Joan Abrams
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Anna Chang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
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Catlin C, Farrell TW, Naik A, Widera E, Moye J. AMERICAN GERIATRICS SOCIETY MEMBER SURVEY ON THE “UNBEFRIENDED”. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Catlin
- Boston VA Research Institute, Providence, Rhode Island, United States
| | | | - A Naik
- Baylor College of Medicine, Houston, TX, USA
| | - E Widera
- University of California, San Francisco, San Francisco, CA, USA
| | - J Moye
- New England Geriatric Research Education and Clinical Center, Boston, MA, USA
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Farrell TW, Luptak MK, Supiano KP, Pacala JT, De Lisser R. State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health. J Am Geriatr Soc 2018; 66 Suppl 1:S40-S47. [DOI: 10.1111/jgs.15309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/08/2018] [Accepted: 01/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy W. Farrell
- School of Medicine; University of Utah; Salt Lake City California
- Geriatric Research, Education, and Clinical Center, Veterans Affairs; Salt Lake City California
- University of Utah Health Interprofessional Education Program; University of Utah; San Francisco California
| | - Marilyn K. Luptak
- College of Social Work; University of Utah; San Francisco California
| | | | - James T. Pacala
- Department of Family Medicine and Community Health; University of Minnesota Medical School; San Francisco California
| | - Rosalind De Lisser
- School of Nursing; University of California, San Francisco; San Francisco California
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Farrell TW, Supiano KP, Wong B, Luptak MK, Luther B, Andersen TC, Wilson R, Wilby F, Yang R, Pepper GA, Brunker CP. Individual versus interprofessional team performance in formulating care transition plans: A randomised study of trainees from five professional groups. J Interprof Care 2017; 32:313-320. [PMID: 29182402 DOI: 10.1080/13561820.2017.1405919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Health professions trainees' performance in teams is rarely evaluated, but increasingly important as the healthcare delivery systems in which they will practice move towards team-based care. Effective management of care transitions is an important aspect of interprofessional teamwork. This mixed-methods study used a crossover design to randomise health professions trainees to work as individuals and as teams to formulate written care transition plans. Experienced external raters assessed the quality of the written care transition plans as well as both the quality of team process and overall team performance. Written care transition plan quality did not vary between individuals and teams (21.8 vs. 24.4, respectively, p = 0.42). The quality of team process did not correlate with the quality of the team-generated written care transition plans (r = -0.172, p = 0.659). However, there was a significant correlation between the quality of team process and overall team performance (r = 0.692, p = 0.039). Teams with highly engaged recorders, performing an internal team debrief, had higher-quality care transition plans. These results suggest that high-quality interprofessional care transition plans may require advance instruction as well as teamwork in finalising the plan.
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Affiliation(s)
- Timothy W Farrell
- a Division of Geriatrics , University of Utah School of Medicine , Salt Lake City , USA.,b University of Utah Health Interprofessional Education Program , Salt Lake City , USA.,c VA Salt Lake City Geriatric Research, Education, and Clinical Center , Salt Lake City , USA
| | | | - Bob Wong
- d University of Utah College of Nursing , Salt Lake City , USA
| | - Marilyn K Luptak
- e University of Utah College of Social Work , Salt Lake City , USA
| | - Brenda Luther
- d University of Utah College of Nursing , Salt Lake City , USA
| | - Troy C Andersen
- e University of Utah College of Social Work , Salt Lake City , USA
| | - Rebecca Wilson
- d University of Utah College of Nursing , Salt Lake City , USA
| | - Frances Wilby
- e University of Utah College of Social Work , Salt Lake City , USA
| | - Rumei Yang
- d University of Utah College of Nursing , Salt Lake City , USA
| | | | - Cherie P Brunker
- a Division of Geriatrics , University of Utah School of Medicine , Salt Lake City , USA.,c VA Salt Lake City Geriatric Research, Education, and Clinical Center , Salt Lake City , USA.,f Department of Medicine, Intermountain Healthcare , Salt Lake City , USA
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Farrell TW, Widera E, Rosenberg L, Rubin CD, Naik AD, Braun U, Torke A, Li I, Vitale C, Shega J. AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults. J Am Geriatr Soc 2016; 65:14-15. [PMID: 27874181 DOI: 10.1111/jgs.14586] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision-making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf. The process of arriving at a treatment decision for an unbefriended older adult should be conducted according to standards of procedural fairness and include capacity assessment, a search for potentially unidentified surrogate decision makers (including non-traditional surrogates) and a team-based effort to ascertain the unbefriended older adult's preferences by synthesizing all available evidence. A concerted national effort is needed to help reduce the significant state-to-state variability in legal approaches to unbefriended patients. Proactive efforts are also needed to identify older adults, including "adult orphans," at risk for becoming unbefriended and to develop alternative approaches to medical decision making for unbefriended older adults. This document updates the 1996 AGS position statement on unbefriended older adults.
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Affiliation(s)
- Timothy W Farrell
- University of Utah School of Medicine, Salt Lake City, UT.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT
| | - Eric Widera
- University of California San Francisco, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Craig D Rubin
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Aanand D Naik
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | - Ursula Braun
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | | | - Ina Li
- Christiana Care Health System, Wilmington, DE
| | - Caroline Vitale
- University of Michigan, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Joseph Shega
- VITAS Hospice Care Healthcare, Gotha, FL.,University of Central Florida, Gotha, FL
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Tomoaia-Cotisel A, Farrell TW, Solberg LI, Berry CA, Calman NS, Cronholm PF, Donahue KE, Driscoll DL, Hauser D, McAllister JW, Mehta SN, Reid RJ, Tai-Seale M, Wise CG, Fetters MD, Holtrop JS, Rodriguez HP, Brunker CP, McGinley EL, Day RL, Scammon DL, Harrison MI, Genevro JL, Gabbay RA, Magill MK. Implementation of Care Management: An Analysis of Recent AHRQ Research. Med Care Res Rev 2016; 75:46-65. [PMID: 27789628 DOI: 10.1177/1077558716673459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.
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Affiliation(s)
- Andrada Tomoaia-Cotisel
- 1 The RAND Corporation, Boston, MA, USA.,2 University of Utah, Salt Lake City, UT, USA.,3 London School of Hygiene and Tropical Medicine, London, UK
| | - Timothy W Farrell
- 2 University of Utah, Salt Lake City, UT, USA.,4 VA Geriatric Research, Education, and Clinical Center, Salt Lake City, UT, USA
| | - Leif I Solberg
- 5 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | | | | | | | | | | | - Diane Hauser
- 7 Institute for Family Health, New York, NY, USA
| | | | - Sanjeev N Mehta
- 12 Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Robert J Reid
- 13 Group Health Research Institute, Seattle, WA, USA
| | - Ming Tai-Seale
- 14 Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | | | | | - Janice L Genevro
- 20 Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Robert A Gabbay
- 12 Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Noonan EM, Farrell TW. Primary Care of the Prostate Cancer Survivor. Am Fam Physician 2016; 93:764-770. [PMID: 27175954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners.
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Affiliation(s)
| | - Timothy W Farrell
- University of Utah School of Medicine and VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT, USA
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Farrell TW, Tomoaia-Cotisel A, Scammon DL, Brunisholz K, Kim J, Day J, Gren LH, Wallace S, Gunning K, Tabler J, Magill MK. Impact of an Integrated Transition Management Program in Primary Care on Hospital Readmissions. J Healthc Qual 2015; 37:81-92. [DOI: 10.1097/01.jhq.0000460119.68190.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shield RR, Farrell TW, Campbell SE, Nanda A, Wetle T. Professional development and exposure to geriatrics: medical student perspectives from narrative journals. Gerontol Geriatr Educ 2014; 36:144-60. [PMID: 25152977 DOI: 10.1080/02701960.2014.954043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students' professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students' professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students' professional development.
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Affiliation(s)
- Renée R Shield
- a Warren Alpert Medical School , Brown University , Providence , Rhode Island , USA
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Scammon DL, Tomoaia-Cotisel A, Day RL, Day J, Kim J, Waitzman NJ, Farrell TW, Magill MK. Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation. Health Serv Res 2013; 48:2181-207. [PMID: 24279836 DOI: 10.1111/1475-6773.12114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. DATA SOURCE/STUDY SETTING An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. STUDY DESIGN Convergent case study mixed methods design. DATA COLLECTION/EXTRACTION METHODS Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. PRINCIPAL FINDINGS Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. CONCLUSIONS Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence.
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Affiliation(s)
- Debra L Scammon
- David Eccles School of Business, University of Utah, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
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Farrell TW, Ozbolt JA, Silvia J, George P. Caring for colleagues, VIPs, friends, and family members. Am Fam Physician 2013; 87:793-795. [PMID: 23939502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Nanda A, Farrell TW, Shield RR, Tomas M, Campbell SE, Wetle T. Medical Students' Recognition and Application of Geriatrics Principles in a New Curriculum. J Am Geriatr Soc 2013; 61:434-9. [DOI: 10.1111/jgs.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Aman Nanda
- Warren Alpert Medical School; Brown University; Providence Rhode Island
| | - Timothy W. Farrell
- Warren Alpert Medical School; Brown University; Providence Rhode Island
- Division of Geriatrics; School of Medicine; University of Utah; Salt Lake City Utah
| | - Renée R. Shield
- Warren Alpert Medical School; Brown University; Providence Rhode Island
| | - Maria Tomas
- Warren Alpert Medical School; Brown University; Providence Rhode Island
- Mid-Columbia Medical Group; The Dalles Oregon
| | - Susan E. Campbell
- Warren Alpert Medical School; Brown University; Providence Rhode Island
| | - Terrie Wetle
- Warren Alpert Medical School; Brown University; Providence Rhode Island
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Farrell TW, Shield RR, Wetle T, Nanda A, Campbell S. Preparing to care for an aging population: medical student reflections on their clinical mentors within a new geriatrics curriculum. Gerontol Geriatr Educ 2013; 34:393-408. [PMID: 24138182 DOI: 10.1080/02701960.2013.830115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Reflective writing techniques such as journaling help provide insights into the process by which medical students are mentored and develop into practicing physicians. The authors sought to analyze medical students' journals regarding their mentored experiences within a new geriatrics curriculum at a U.S. medical school. Thirty preclinical and clinical medical student journalers participated in this project. The authors employed qualitative analytic techniques using an interdisciplinary team process. Three major themes emerged: (a) exposure to clinical mentors challenged medical students' preconceptions regarding older adults and geriatric medicine; (b) students learned new medical knowledge and techniques from observing their mentors; and (c) students provided positive and negative assessments of their mentors. Reflective journaling provides important insights into the process by which medical students draw upon mentored clinical experiences during their training. Such mentorship may be particularly relevant to promoting their interest in geriatrics.
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Affiliation(s)
- Timothy W Farrell
- a Division of Geriatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
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George P, Farrell TW, Griswold MF. Hearing loss: help for the young and old. J Fam Pract 2012; 61:268-277. [PMID: 22577629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Two simple questions (one for parents of newborns, one for older patients) can improve hearing loss identification. Hearing aid troubleshooting tips can help you overcome 6 common patient objections.
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Affiliation(s)
- Paul George
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Farrell TW, Campbell S, Nanda A, Shield R, Wetle T. Evaluating geriatrics in the medical school curriculum: using student journals. Med Health R I 2008; 91:378-381. [PMID: 19170314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, The Warren Alpert Medical School of Brown University, USA.
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Farrell TW, Chandran R, Gramling R. Understanding the role of shame in the clinical assessment of health literacy. Fam Med 2008; 40:235-236. [PMID: 18382832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Farrell TW, Dosa D. The assessment and management of hypoactive delirium. Med Health R I 2007; 90:393-395. [PMID: 18314832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Rhode Island Hospital, Providence 02903, USA.
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Farrell TW. Managed care, electronic charting and documentation. Benders Health Care Law Mon 1995:10-4. [PMID: 10158646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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46
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Farrell TW. Survey into on-site radiology services in general practice. Aust Fam Physician 1977; 6:1585-9. [PMID: 603453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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