OBJECTIVES:

To determine whether outpatient care provided to older patients by fellowship-trained geriatricians is distinguishable from that provided by generalists.

DESIGN:

Observational study.

SETTING:

Three primary care clinics of an academic medical center.

PARTICIPANTS:

Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics.

MEASUREMENTS:

A medical chart review involving records of 69 patients receiving primary care from a fellowship-trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults--avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes--was abstracted.

RESULTS:

Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (beta coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57-8.94).

CONCLUSION:

The practice style of fellowship-trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.