Towards Integrated Perioperative Medicine: a Survey of General Practitioners' Attitudes, Beliefs and Behaviours Regarding Perioperative Medicine for Older People

Overview

Journal Clin Med (Lond)

Specialty General Medicine

Date 2021 Mar 25

PMID 33762386

Authors

Tessa OHalloran

Jessie Colquhoun

Gerard Danjoux

Judith Sl Partridge

Jugdeep K Dhesi

Affiliations

Soon will be listed here.

Abstract

Background: Perioperative optimisation can improve outcomes for older people having surgery. Integration with primary care could improve quality and reduce variability in access to preoperative optimisation.

Aim: Our aim was to explore attitudes, beliefs and behaviours of general practitioners (GPs) regarding the perioperative pathway, and evaluate enablers and barriers to GP-led preoperative optimisation.

Methods: Stakeholder interviews (n=38) informed survey development. A purposive sampling frame was used to target delivery of online and paper surveys. Results were analysed using descriptive statistics.

Results: We had 231 responses (response rate 32.7%). Enablers included belief among GPs that optimisation improves postoperative outcomes (86%) and that they have a role discussing modifiable risk factors with patients (85%). Barriers included low frequency exposure to older surgical patients, minimal training in perioperative medicine and rare interaction with perioperative services.

Conclusion: This survey illustrates the importance of interprofessional education, cross-sector training opportunities and collaboration to deliver integrated preoperative optimisation for older people undergoing surgery.

References

Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B . Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836):37-43. DOI: 10.1016/S0140-6736(12)60240-2. View

Fowler A, Abbott T, Prowle J, Pearse R . Age of patients undergoing surgery. Br J Surg. 2019; 106(8):1012-1018. DOI: 10.1002/bjs.11148. View

Bonevski B, Magin P, Horton G, Foster M, Girgis A . Response rates in GP surveys - trialling two recruitment strategies. Aust Fam Physician. 2011; 40(6):427-30. View

Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F . Proactive care of older people undergoing surgery ('POPS'): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing. 2007; 36(2):190-6. DOI: 10.1093/ageing/afl163. View

Partridge J, Harari D, Martin F, Peacock J, Bell R, Mohammed A . Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg. 2017; 104(6):679-687. DOI: 10.1002/bjs.10459. View

Rogerson A, Partridge J, Dhesi J . A Foundation Programme educational placement in peri-operative medicine for older people: mixed methods evaluation. Anaesthesia. 2018; 73(11):1392-1399. DOI: 10.1111/anae.14410. View

Tsianakas V, Robert G, Maben J, Richardson A, Dale C, Griffin M . Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services. Support Care Cancer. 2012; 20(11):2639-47. PMC: 3461206. DOI: 10.1007/s00520-012-1470-3. View

Barber S, Singleton E, Partridge J, Dhesi J . Training doctors in perioperative medicine for older people undergoing surgery (POPS): an innovative foundation placement. Clin Med (Lond). 2019; 19(6):465-467. PMC: 6899244. DOI: 10.7861/clinmed.2019-0256. View

Khuri S, Henderson W, DePalma R, Mosca C, Healey N, Kumbhani D . Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005; 242(3):326-41. PMC: 1357741. DOI: 10.1097/01.sla.0000179621.33268.83. View

10.

Grocott M . Pathway redesign: putting patients ahead of professionals. Clin Med (Lond). 2019; 19(6):468-472. PMC: 6899248. DOI: 10.7861/clinmed.2019-0292. View

11.

Griffiths R, Beech F, Brown A, Dhesi J, Foo I, Goodall J . Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2013; 69 Suppl 1:81-98. DOI: 10.1111/anae.12524. View

12.

Joughin A, Partridge J, OHalloran T, Dhesi J . Where are we now in perioperative medicine? Results from a repeated UK survey of geriatric medicine delivered services for older people. Age Ageing. 2019; 48(3):458-462. DOI: 10.1093/ageing/afy218. View

13.

Spinelli A, Pellino G . COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020; 107(7):785-787. PMC: 7228411. DOI: 10.1002/bjs.11627. View

14.

Dasgupta M, Rolfson D, Stolee P, Borrie M, Speechley M . Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2007; 48(1):78-83. DOI: 10.1016/j.archger.2007.10.007. View

15.

Howie S, Tinker A . Are we on the same page? Exploring the role of the geriatrician in the care of the older surgical patient from the perspective of surgeons and geriatricians. Clin Med (Lond). 2018; 18(5):374-379. PMC: 6334106. DOI: 10.7861/clinmedicine.18-5-374. View

16.

Asch D, Jedrziewski M, Christakis N . Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997; 50(10):1129-36. DOI: 10.1016/s0895-4356(97)00126-1. View

17.

Klopfenstein C, Herrmann F, Michel J, Clergue F, Forster A . The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg. 1998; 86(6):1165-70. DOI: 10.1097/00000539-199806000-00005. View