SPECIAL SERIES: THE ASSOCIATION OF DIRECTORS OF GERIATRIC ACADEMIC PROGRAMS SYMPOSIUM A Comparison of How Generalists and Fellowship-Trained Geriatricians Provide ''Geriatric'' Care

OBJECTIVES: To determine whether outpatient care pro-videdtoolder patients by fellowship-trained geriatricians isdistinguishable from that provided by generalists.DESIGN: Observational study.SETTING: Three primary care clinics of an academicmedical center.PARTICIPANTS: Random sample of 140 adults aged 65and older receiving primary care at one of the clinics.MEASUREMENTS: A medical chart review involving re-cordsof69patientsreceivingprimarycarefromafellowship-trained geriatrician and 71 patients receiving primary carefrom a generalist (general internal medicine or family prac-tice) was conducted; information pertaining to two practicebehaviors relevant to the care of older adults Favoidanceof inappropriate prescribing and proactive assessments forgeriatric syndromesFwas abstracted.RESULTS: Geriatricians scored 17.6 out of a possible 24points, on average; generalists scored 14.2 (Po.001). Ger-iatricians scored higher than generalists on prescribing andgeriatricsyndromeassessments.Inalinearregressionmodeladjusting for patient age and number of comorbidities andclustering according to provider, provider specialty wasstrongly associated with overall score (b coefficient for spe-cialty56.75, Po.001; 95% confidence interval54.57–8.94).CONCLUSION: The practice style of fellowship-trainedgeriatricians caring for older adults appears to differ fromthat of generalists with regard to prescribing behavior andassessment for geriatric syndromes. J Am Geriatr Soc56:1807–1811, 2008.Key words: aged; health services for the aged/standards;physicians; practice patterns; ambulatory care/patterns;fee-for-service plans/standards; health services research;quality of health care; United States