Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Abstract

Objectives: To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT).

Design: Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members.

Setting: GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems.

Participants: GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67).

Measurements: Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework.

Results: Using the PACT Resources Framework, we identified facility-, clinic-, and team-level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams.

Conclusion: Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource-trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real-time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.

Keywords: patient-centered medical home; primary care; qualitative research; veterans.

Figure 1.

Illustration of GeriPACT model. A GeriPACT is composed of six core members who share interprofessional knowledge, psychological safety, and a shared sense of urgency to meet the needs of older adults with complex comorbidity in near real time. GeriPACT core members (illustrated in gray) augment their expertise with that of extended team (illustrated in green) specialty provider members.