Family Practice Vol. 19, No. 5, 568-569
© Oxford University Press 2002
Book Review |
An evidence-based approach to assessing older people in primary care. Occasional Paper 82.
EI Williams, G Fischer, U Junius, H Sandholzer, D Jones, M Vass (eds). (55 pages, £10.) Royal College of General Practitioners, 2002. ISBN 0-85084-274-3.
Retired GP, London
Only a few years ago, GPs in the UK were paid a small premium for undertaking routine health checks of their older patients. There was not much evidence that such action would do any good nor did anyone specify what constituted a proper check-up. Those who liked their elderly patients, used the time to chat to them, while other more stressed primary care workers fudged the issue. But many elderly patients are undemanding and don’t complain about, much less seek help for, their slowly increasing problems, whether they can be remedied or not. So, all too often, elderly patients receive less health care than they should and much treatable pathology goes unnoticed, almost regardless of whether they have check-ups.
There is a good case to be made in favour of actively seeking out undiagnosed conditions that will respond to active management, and this valuable publication from the Royal College of General Practitioners is most timely. It is the product of an inter-professional collaboration between participants from seven countries in Europe. Their aim was to develop a system for effective health and social assessment in primary care of older people. Further, they decided that theirs was to be a proactive procedure, based firmly on valid research evidence, and leading to actions that would be appropriate right across the continent. They set out to encourage what was unequivocally worthwhile and omit activities that had no proven worth. So they searched the literature, graded the evidence for quality and then refined it by applying an extra filter—the preventive primary care impact factor (PPCIF)—representing the whole panel’s perception of how worthwhile each proposed intervention seems to be.
Inevitably, there are gaps in the supportive evidence and, for these, the panel offers a consensus view, clearly marked as such. We are given a quality graded outline of the evidence for every course of action that they suggest, brought together into a summary document that then needs to be interpreted locally, taking national, cultural and political realities into account. This Occasional Paper provides both the basic document and a version of the planned process—a questionnaire and the recommended follow-ups to be done—suitable for health workers in the UK. This is supplemented with a number of standard health questionnaires that can be valuable in further assessment of patients found to need more tests.
To me, this seems to be a most useful piece of work. There can now be no more equivocation about what preventive health checks for the elderly are worthwhile, for every recommendation made here is clearly graded for value. The problem will always remain to decide exactly who in the primary care team will do what and then finding the time and resources to deliver the goods. Everyone who looks after elderly people must read and will value this short booklet. I hope my own GP will have finished it in time for my next check-up.
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