Study: Nurses Can Take Greater Leadership Roles in Primary Care for Seniors

A nurse-led, interdisciplinary approach to geriatric care improved primary care outcomes for older adults.

That’s according to a group of reports evaluating the approach at five primary care practices in the December 2023 edition of the Journal of the American Geriatrics Society.

Researchers wrote that the Geriatric Interdisciplinary Team Training Program (GITT) could be implemented in primary care settings and focuses on, among other things, enabling registered nurses (RNs) to lead and optimize annual well-care visits.

The GITT program was originally conceived in 2008 using knowledge from a U.S. Department of Veterans Affairs project on interdisciplinary team training. The GITT program was designed to create training models to address the needs of caring for older adults with complex health conditions. The GITT-Primary Care (GITT-PC) model was developed to meet the needs of senior adults in the community.

“These outcomes indicated that the model had no significant negative impact on the clinical staff, and, by many measures, introduced significant and sustainable improvements,” wrote study first author Ellen Flaherty, Ph.D., APRN, AGSF, and colleagues. “The GITT-PC model emerges in this analysis as an effective strategy to improve the care of older adults in primary care.”

The evaluation of GITT-PC occurred in practices with fewer than 7,500 patients and fewer than 10 providers on staff. When the study began, only one practice was experienced in conducting primary care nurse-led annual wellness visits.

For the study, the interdisciplinary team was trained on quality improvement, application of Medicare codes, and clinical skills using online learning modules, live (virtual) training, team-building exercises, and monthly meetings to track progress. The training was administered using a web-based learning management system.

Since the evaluation was limited to a relatively homogeneous area, the researchers believe it’s possible that implementation in a more demographically diverse patient and provider population may have different challenges and potentially slightly different results.

GITT-PC focuses on health promotion and prevention, chronic disease management, advanced care planning, and transitional care management. These core components correspond to Medicare reimbursable visits, which the researchers found to be a financially sustainable model.

One study looked at the prevention-focused Medicare annual wellness visits to evaluate an RN-led Medicare visit in primary care that implemented a focus on “what matters,” medication, mentation, and mobility, which the researchers referred to as the 4 “M”s of age-friendly healthcare.

The researchers concluded that by incorporating the 4 “M” framework, the nurse-led Medicare annual wellness visits enhanced the role of the registered nurse and utilized the nurse to the full scope of practice.

In the final paper, the researchers acknowledged the importance of supporting older adults to remain independent, which requires an interprofessional approach where the needs of the patient are coordinated. They went on to describe the process for integrating primary and community-based care as well as making recommendations for implementation.

The data from the 2023 studies support a 2019 paper by the same primary researcher in which they found the increasing demand for quality health care in the coming years would be significantly and negatively impacted by the primary care physician shortage. The researchers explored ways that this might be addressed, including creating a nurse-led annual wellness visit for community-based geriatric healthcare.

Using a more integrated approach has demonstrated positive benefits, especially when caring for older adults with complex health conditions and barriers to receiving care. In 2023, the researchers wrote that the analysis of the data suggested changes to the annual wellness visits for geriatric adults would not necessarily require a change in the regulatory environment.

“Specifically, a revision to the electronic health record to emphasize a patient’s personal health goals would promote patient-centered care and foster more meaningful relationships between the patient and the primary care practice team,” they wrote.

After compiling the data from the five primary care practices and looking at the model from three different perspectives, the researchers found that at a minimum, the model had no negative impact on primary care for seniors and demonstrated some significant and sustainable improvements to the care of older adults in primary care practices.

These preliminary results demonstrated how using registered primary care nurses to the full extent of their practice could extend and improve primary care treatment for older adults, especially in areas where primary care physician shortages are growing. The model specifically addressed community-dwelling senior care in a primarily white population with applications that can potentially be implemented with success in a demographically diverse patient and physician population.