Dr Troy's "Thought Provocateur" Session on Advancing Family Medicine through Geriatrics and Long Term Care

Warwick Troy, Ph.D.; Shueman-Troy Associates, Pasadena, California
Warwick Troy, Ph.D.; Shueman-Troy Associates, Pasadena, California

[At the Twentieth National Conference, a new feature, “The Thought Provocateur” session, was instituted to focus on particular ideas of relevance to the general issues of primary health care access. This year Warwick Troy, Ph.D., a National Consortium fellow, proposes a revisiting of the subjects of geriatric medicine and long term care.]

Dr Troy’s presentation will introduce and analyze two recent  proposals for improving health workforce competencies: (1) for geriatrics and (2) for accountable services development in long term care. These approaches use community-based imperatives to plan and deliver accountable professional competencies and services critical to the spirit and substance of primary care.

Warwick Troy, Ph.D.

These proposals address the needs of a diverse, vulnerable and resource-poor community whose needs have been shamefully neglected for decades; and in so doing they are uniquely responsive to the core theme of this 21st National Conference – “Consequences” – in this case, the consequences of neglect.  Specific legislation is proposed: at very least a possible harbinger of  “services on the ground.”

A caveat: although this presentation is made in the context of health “reform,” it must be noted that one of its foci – long term care – has not been taken up, operationally at least, by health reform submissions.  This is hardly unexpected and, as the presentation will suggest, will someday reap its own dire “Consequences.”

Again, unlike long term care, its bedfellow and our other focus – expanded training in geriatrics – which derives from a medical and not a social services context, would seem to have some realistic hope of implementation within medical schools in the nearer future.

The presentation will invoke a number of seminal issues that have figured prominently previous National Conferences, including community-based medicine, the “Future of Family Medicine” reports, and integrated care (multi/interdisciplinary service delivery).

INTRODUCTION: Three recent reports, (1) Advancing Long-term Services and Supports, published in late December 2009 in Health Affairs; (2) Retooling for an Aging America, published in April 2008 by the IOM and prepared by the Committee on the Future Health Care Workforce for Older Americans; and (3) Grand Challenges of Our Aging Society: Workshop Summary developed under the auspices of the National Research Council of the National Academies and published this year, are as interesting for the timing of their appearance as for their challenging and usefully overlapping content.

In different ways each compelling speaks to a critical, but continuously neglected, social policy issue – health related and social services for an aging population – that for two decades has been taken up and then dropped by numerous national bodies and committees. Now they surface yet again at the very time health care reform is commanding the national political stage. It’s more than past time, and the stakes are high.

PRESENTATION: In briefly analyzing these two reports, Dr. Troy will assert that, after decades, the consequences of not attending to this bedeviled field can no longer be ignored.  The grievous cost of looking beyond a needy population of over 40 million has indisputably caught up.  It will also be claimed that the imperatives of health reform bring into sharp focus a set of realizable opportunities for Family Medicine practitioners, students and postgraduate residents, and primary care group practices.  If resolutely grasped, such opportunities should serve the specialties and the wider community very well.

Accordingly, the presentation will reaffirm traditional and emergent roles for the FM specialty, including population-based planning and services; “integrated care” and interdisciplinary teams; collaborative initiatives; continuous assessment of quality of care; more routine and flexible use of “allied health” professionals and direct care personnel; public education; routine and expert use of health information technology; and diversity issues in practice.  These issues will be highlighted and analyzed in the context of critical elements of the reports.

ENDPOINTS: It will be argued that the reports offer exemplars of “advanced primary care in action,” benefits accruing to individual providers, their practices and patients.  Importantly, gaining and demonstrating expertise in long-term care management could both serve the public in critically important ways while advancing the realization of the Future of Family Medicine.