Use of geriatrics at your fingertips, a pocket guide, to educate physiatrists in geriatric care¹ ☆

Article Outline

• Abstract
• Methods
• Results
• Discussion
• Conclusions
• Acknowledgements
• References
• Copyright

Abstract 

Siebens H, Tucker J, Leander K. Use of Geriatrics At Your Fingertips, a pocket guide, to educate physiatrists in geriatric care. Arch Phys Med Rehabil 2004;85:1552–4.

Objective

To determine whether a geriatric pocket guide, Geriatrics At Your Fingertips, may be a useful tool in educating physiatrists about the care of their older patients.

Design

Geriatrics At Your Fingertips was distributed through the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to physical medicine and rehabilitation (PM&R) residents and practicing physiatrists. Two questionnaires evaluated guide use.

Setting

Two academic PM&R departments and physiatrists in the United States.

Participants

Two PM&R residency programs, members of AAPM&R’s Geriatric Rehabilitation Special Interest Group (GR-SIG), and AAPM&R’s membership.

Interventions

Not applicable.

Main Outcome Measures

Identification of clinically useful information by residents and GR-SIG members and frequency of guide use among AAPM&R membership.

Results

Forty-five PM&R residents and 17 GR-SIG members reported examples of useful information. Geriatrics At Your Fingertips was requested by 483 AAPM&R members. Forty-six percent returned questionnaires (N=223). Seventy percent had used the guide at least once and 49% 4 or more times.

Conclusions

Geriatrics At Your Fingertips is a useful tool with which to educate PM&R residents and physiatrists about geriatric care.

Keywords:  Education, medical, Geriatrics, Learning, Physical medicine, Rehabilitation

PHYSIATRISTS AND RESIDENTS in physical medicine and rehabilitation (PM&R) diagnose and manage many illnesses in older adults. This older population (≥65y) will double by 2050, with those 85 years of age and older increasing by 350%.1 In addition, a national emphasis on improving health care quality requires increased physician education on ways of meeting specific patient care needs. For seniors, principles of good geriatric care overlap with good rehabilitation care.2, 3, 4 Especially critical are functional assessment, prevention of predictable disasters, identification and treatment of multiple coexisting problems (“the management of complexity”), seeking cumulative small gains in function, aggressive rehabilitation, interdisciplinary team care, careful attention to social support status, guarding patients’ autonomy in end-of-life decision making, and understanding the effect of varying degrees of dementia on the clinical setting.5 How can PM&R residents and physiatrists effectively learn more about good geriatric care?

The Geriatric Rehabilitation Special Interest Group (GR-SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) sponsored an educational project that distributed the pocket guide Geriatrics At Your Fingertips as a tool to educate physiatrists.6 The guide includes general background as well as specific management information. Its pocket size makes it easy to use during a patient encounter when a physician needs new information (and is most likely to learn). Annual updates add current evidence-based information. Geriatrics At Your Fingertips has characteristics described as important for any continuing medical education modality: convenience, relevance, and individualization (ie, it allows learners input into what is learned).7 The cost of the guide, $11.95 for single copies (less in bulk), is very reasonable. The guide will be available in electronic format in 2004.

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Methods 

The pocket guide was sent free of charge to 2 PM&R residency programs. Residents were given a letter and questionnaire that asked them to write down a single specific example of useful information they found in the guide while directly taking care of patients. The residency programs were each given a $1000 educational stipend once all of the assessment forms were returned. Free copies of the pocket guide were sent with the same questionnaire (and $100 honorarium on questionnaire completion) to GR-SIG members who requested copies.

AAPM&R members received mailed announcements of the availability of a free copy of the guide in the membership newsletter The Physiatrist. Guides were mailed to those physiatrists requesting copies, followed 1 to 2 months later by a brief questionnaire.

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Results 

Residents completed 45 assessment forms describing clinical vignettes in which the guide provided useful information (table 1). Fifty-three percent of patient cases involved female patients. Age distribution was 65 to 70 years old (31%), 71 to 75 years old (33%), 76 to 80 years old (18%), and 81 years or over (17%). The residents cited 62 pieces of helpful information: 32% concerned drug therapy, 27% concerned diagnosis, 24% concerned nonmedication treatment, and 16% covered general information. Clinical information in geriatrics is needed in 4 domains: I. Medical/Surgical Issues, II. Mental Status/Emotions/Coping, III. Physical Function, and IV. Living Environment.8 Information used by the residents was distributed as follows: 66% in Domain I, 26% in Domain II, 2% in Domain III, and none in Domain IV. Four comments specifically identified patient improvement and that physician-patient-family interactions were positive as a result of applying the information. Interestingly, 1 resident reported improved clinical confidence as a result of applying information.

Table 1. Examples of Information Used by Residents

Abbreviations: ADL; activities of daily living; dx, diagnosis; GI, gastrointestinal; NSAIDs, nonsteriodal anti-inflammatory drugs; SIADH, syndrome of inappropriate antidiuretic hormone secretion; S/p, status post; TB, tuberculosis; TSH, thyroid-stimulating hormone.

The GR-SIG members completed 17 assessment forms, with a total of 21 pieces of useful information identified. Fifty-nine percent of these cases involved female patients, and 35% were over 80 years old. Sixty-one percent of comments concerned medication management, 24% diagnosis, and 14% nonmedication management. Two comments noted that patients improved as a result of using the information from the guide. One comment stated “This book is really helpful.”

Four hundred eighty-three AAPM&R members requested free copies of the guide. A total of 223 (46%) returned the follow-up questionnaire. Among the respondents, 70% (n=156) had used the guide. Forty-nine percent had used it 4 or more times, with 13% using it 10 or more times.

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Discussion 

These results indicate that physiatrists found clinically useful information in the guide. Sustained use of educational tools or new information frequently requires reinforcement. The repeated use of the guide by many physicians, without specific reinforcement, suggests that the guide is an effective teaching and learning tool.

Improved patient outcomes are the ultimate goal of physician education efforts. In this study, patient outcomes were improved as described qualitatively in some vignettes. Whether these improvements would have occurred through use of other information sources is unclear. Further evaluation can clarify the relationship between the guide’s use and improved patient outcomes.

The generalizability of the use of Geriatrics At Your Fingertips in other residency programs and for practicing physiatrists was not fully established by this study. The residency program faculty encouraged this research project. Whether residents would use the guide without faculty support is unclear. However, given the residents’ responses and the low cost of the guide, the guide may be appropriate for all PM&R residency programs. Several other residency programs had already distributed the guide prior to this study.

As for physiatrists who have completed their formal medical training, this study included only physiatrists who volunteered to use the guide. These were the physicians who acknowledged a need for possible new information in the care of their older patients. Sending educational information, unsolicited, to physicians is not likely to be useful given the potential lack of perception of need, the extensive amount of print material sent to doctors routinely, and the huge number of information sources already available. Results of this study, however, may alert other physiatrists that this particular guide may be among the more helpful resources for geriatric care.

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Conclusions 

This preliminary study suggests that Geriatrics At Your Fingertips is a useful tool for educating PM&R residents and physiatrists about geriatric care.

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Acknowledgements 

We thank Damon Marquis, MS, for his strong and creative support.

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References 

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• 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.