The perceived performance, barriers and solutions for the good preventive care of elderly people in Israel

Background Many elderly people, who experience functional and cognitive deterioration, visit their family physician or general practitioner (GP) who is well placed to administer preventive care; however, this provision is often suboptimal. Aim To examine barriers to preventive care among the elderly and examine self-perceived skills and knowledge among Israeli physicians. Design Quantitative and qualitative research methods involving focus groups were used. Setting Two Israeli primary care preferred provider organisations. Methods Eighty-five physicians participated in 12 focus group discussions on preventive medicine for the elderly. The discussions were analysed using Atlas.ti software. Before each discussion, the physicians answered a self-report questionnaire which addressed his or her perceived skills in these areas. Results Family physicians felt less skilled in identifying cognitive deterioration, detecting signs of depression or treating urinary incontinence than in dealing with visual decline, and reported fewer skills than geriatricians. Most of the GPs felt that preventive medicine in the elderly was worthwhile but that they lacked the time and skills to undertake this task. Proposed solutions included the need for educational and training programmes, protected time, incentives and the involvement of nurses. Conclusion Although the issue of 'lack of time' is usually considered a major barrier to successful implementation of preventive care, lack of family physician knowledge and skills, and organisational barriers should also be addressed.