Educational needs of family physicians in the Republic of Moldova in the context of Comprehensive Geriatric Assessment

Abstract

Introduction. The population of the Republic of Moldova is about 36 mln. The 65 years old and elder persons represent about 10% of the whole population. During last 10 years the population number is decreasing from 3.639 thousands, in 2000, to 3 562 thousands in 2010. At the same time, the rate of the aged population of the country is increasing - from 325 200 persons, in 2000, to 329 700 persons, in 2011. The aging population was the subject of the study conducted on the request of the National Commission for Population and Development. The health of elderly people and the acces to medical services have been investigated in terms of health self-esteem, existence of chronic diseases and disability, medication use, access to health services and the existence of functional limitations caused by health and need for assistance. According to the esteem of the personal health over the last 10 years, there have increased both, the number of people who believe their state of health as being good and very good, as well as the amount of those who find their state as a bad and very bad one. The seniors’ opinion varies depending on their age and their gender. The number of the persons who were registered as having a disability has also increased. It is also observed an increasing of the proportion of elderly people affected by chronic diseases. The care for elderly people having complex problems requires the collaboration between care-givers, and it strongly depends on the responsible organization. In order to tailor the care in accordance to the individual need of elders, the assessment has to be organized at a lower aggregation level (districts) where professionals know each other well and agreements can be adjusted to local conditions. The urgent need of educating general practitioners about the “new geriatric approaches” is obvious, as patients 65 and older currently comprise 28% of the physician workload in primary care. The Comprehensive Geriatric Assessment (CGA) differs from a standard medical evaluation in three general ways: it focuses on elderly individuals with complex problems, it emphasizes functional status and quality of life, and it frequently takes advantage of an interdisciplinary team of providers. It can be effective only if there is a process for identifying elderly patients who may benefit from it. In the most of cases, they are elderly individuals who are frail and disabled or who have multiple interacting comorbidities, as opposed to relatively healthy older people whose health conditions are addressable by usual medical approaches, and those with serious focal chronic conditions, for whose disease management by primary care with input by other subspecialists is appropriate. Material and methods The educational needs assessment is going to be done, in order to help primary care team with introduction of CGA, by using an evaluation of the competence level of 50 family physicians and nurses through case study methodology. At the same time the number of medical records will be examined to determine the lack of knowledge in the field of Geriatric Care. Results The proposed activities and collaboration, will allow the “Scientific Perspective”, which is a non-commercial organization of researches on health care, from Sainkt-Petersburg, Russia (www. crystalproject.ru), to share its experience on CGA with primary care providers from our country. Our common goal is to disseminate more widely the good practice in Elderly Care and to act for the benefit of aged persons in Moldova.