Nurse practitioners can boost quality of care for older patients with chronic conditions

U.S. residents today are living longer than previous generations, thanks to improved public health and medical treatment. But they're also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care.

Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions.

Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments. One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings?

The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study's findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions.

"It is becoming increasingly clear that care of chronic geriatric conditions is better when it's done in teams," said the study's lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA. "There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners."

Reuben noted that while doctors are generally good at treating acute medical conditions and those requiring highly complex decision-making, some chronic conditions tend to be "swept by the wayside" because physicians either don't have the time or are simply not as skilled in dealing with them.

In addition, doctors often can't make the time to deal with both patient symptoms and the management of chronic illnesses that may not have acute symptoms. "There just isn't enough time in the office to do both," Reuben said.

For the current study, researchers screened 1,084 patients at two primary care facilities in Southern California for four chronic geriatric conditions: falls, urinary incontinence, dementia/Alzheimer's disease, and depression. Of those patients, 658 had at least one condition; 485 of the 658 patients were then randomly selected for medical review.

Of those 485 patients, 237 (49 percent) were seen by a nurse practitioner, for co-management with a primary care physician of at least one condition. The rest were seen only by a primary care physician.

The researchers examined whether a set of measures known as "quality indicators" were performed for each condition. For example, if a patient had a history of falls, did the care provider assess whether the patient might be taking medications that increase the risk of falls and assist the patient in reducing or stopping the use of that drug?