Providing medical care to older people can be complicated. People often have many different health care practitioners at different locations. Travel and transportation issues become more difficult as people age. The medications that are covered by the Medicare prescription drug plan vary between insurance companies and change frequently. Assistance by a team of health care practitioners under the leadership of a primary care physician or a doctor who specializes in the care of older people (geriatrician) is the best way to deal with these complexities.
Continuity of care is an ideal in which health care is provided for a person in a coordinated manner and without disruption despite all the complexities of the health care system and the involvement of different practitioners in different care settings. Also, all people involved in a person’s health care, including the person receiving care, communicate and work with each other to coordinate health care and to set goals for health care.
However, continuity of care is not always easy to accomplish, especially in the United States, where the health care system is complicated and fragmented. When continuity of care is missing, people may not adequately understand their health care problems and may not know which practitioner to talk to when they have problems or questions.
Challenges to Continuity of care
Continuity of care is a particular concern for older people. Older people are particularly likely to have several practitioners (each specializing in one organ system or problem) and thus to move from one care setting to another (called transition of care). They may receive care in several private practitioner offices, in a hospital, in a rehabilitation facility, and/or in a long-term facility.
Strategies to Improve Continuity of care
Improving continuity of care requires efforts by the health care system, by the people receiving care, and by family members.
Health Care System
Managed care organizations and some government health care plans coordinate all health care and thus contribute to continuity of care. Also, the health care system has developed several strategies to improve continuity of care. Examples are
Interdisciplinary care
Geriatric care managers
Electronic medical records
People Receiving Care
To help improve the continuity of their care, older people and their caregivers (whether family members, people outside the family, or both) can take an active part in their care. For example, they can learn more about what can interfere with continuity, how the health care system works, and what resources (such as care managers or social workers) are available to improve continuity of care. Being familiar with their disorders and the details of their health insurance plan can also help.
Active participation begins with communication—giving and getting information. When older people have special health care needs or questions, they or their family members should tell their health care practitioners. For example, older people often need help determining which medications are covered by their Medicare prescription drug plan.
People who are receiving care or their family members need to become proactive in care. For example, older people, or their caregivers, need to establish an ongoing relationship with at least one health care practitioner, usually the primary care practitioner, to minimize the problems created by having several health care practitioners. Older people should make sure the primary care practitioner is aware of changes in their condition and their medications, especially when a specialist has made a new diagnosis or changed a treatment regimen. They may need to ask one health care practitioner to call and talk with another to make sure that information is communicated clearly and that treatment is appropriate.
Active participation means asking questions about a disorder, treatment, or other aspects of care. It also includes learning how to prevent disorders and taking the appropriate steps to do so.
For people who have a disorder, active participation often involves following a healthy lifestyle. For example, people with high blood pressure can follow a heart-healthy diet and exercise regularly. People can also monitor their condition at home. For example, people with high blood pressure can check their blood pressure, and people with diabetes can measure the level of sugar in their blood.
Keeping a copy of their medical record can help people participate in their health care. They can often obtain a copy from their primary care practitioner. A copy of the medical record is useful as a reference for information about current disorders, medications being taken, treatments and tests done, and payments made. This information can also help people explain a problem to other health care practitioners. File boxes, binders, computer software, and internet programs have been designed for this purpose. Additionally, many doctors' offices provide secure, online portals that people can access to view their laboratory results, prescription information, and summaries of office visits.
When more than one practitioner is involved, people can keep their own records of their care, including the type and date of examinations and procedures and a list of their diagnoses. At a minimum, people should keep a record of all medications (prescription and nonprescription) they are currently taking, plus the doses and the reason they are taking the medication. They should bring this record with them each time they visit a doctor.
When people go to a hospital or to a new health care practitioner, they should check with someone at the new location to make sure that their medical record has been received.
Buying all medications (prescription and nonprescription) at one pharmacy or through one mail order service and getting to know a pharmacist there are also important. Older people can ask their pharmacist questions about the medications they are taking. They can also ask for containers that are easy to open and labels that are easy to read.
