Asian Pacific elders. Implications for health care providers.

Asian Pacific Islanders are a diverse group that include recent immigrants as well as long-term residents. They may be isolated or unsettled in their relationships with their own families and unfamiliar with Western medical care and thought. Medical care should take into consideration unique features of their traditional health benefits, traditional medications, prevalence of medical problems, pharmacokinetics and pharmacodynamics, diet, health risks, and health promotion. Although they cannot be homogenized into one tidy bundle, certain commonalities apply, and are addressed.

Ethnogeriatric assessment clinic in family medicine.

BACKGROUND: The Department of Family Medicine at the University of California-Irvine needed a way to teach resident physicians care of ethnic elders and to provide specific training experiences in the use of geriatric assessment tools. The development of the ethnogeriatric assessment clinic presented the opportunity to do both. PROGRAM DESCRIPTION: The clinic is part of a cross-cultural geriatrics curriculum spanning the 3-year residency program that includes didactic learning, clinical experience, and a research project. Residents learn the drawbacks of working with translators, use of validated assessment tools, integration of assessment into practice, how home visits contribute unique information, and research aspects of health care of various ethnic groups. PROGRAM EVALUATION: Residents surveyed about their experience in the clinical and rotation uniformly felt it contributed to their knowledge base. Patients surveyed felt they benefited from the evaluation, especially from reassurance about their condition and information about community services. DISCUSSION: Developing the ethnogeriatric assessment clinic has benefited the family practice residents and patients, and it has helped address cross-cultural and geriatric issues for an expanding minority population.

Adult immunization in a network of family practice residency programs.

A substantial proportion of morbidity and mortality associated with vaccine-preventable diseases occurs among adults. Teaching residents about disease prevention is mandated in the curriculum guidelines for family practice programs. A cooperative study among the Kansas City family practice residency programs was begun to look at immunization behaviors in these teaching programs. A retrospective audit of medical records and a prospective survey of residents and faculty were performed. From the medical records of 400 patients seen for health maintenance examinations, the frequency of tetanus-diphtheria immunizations recorded was 4.75%. The pooled immunization rate recorded for pneumococcal vaccine was 25%, and for influenza vaccine, 24%. Although 93% of respondents knew patients need tetanus-diphtheria immunization every 10 years, on a written questionnaire giving clinical examples, they were less likely to elect to immunize older patients eligible for tetanus-diphtheria vaccine. The following immunization criteria were listed by respondents: for pneumococcal vaccine, age over 65 years (86%); for influenza vaccine, age over 65 years (85%), chronic diseases (69%), residence in a chronic care facility (7%), and being a health care worker (28%). Educational interventions stressing the appropriate criteria and involvement of the patient are planned at the separate programs.