Official websites use. Share sensitive information only on official, secure websites. As the population ages, the quantity and complexity of comorbidities only increases in the primary care setting. Health systems strive to improve quality of care and enhance cost savings, but current administrative and payment systems do not easily support the implementation of existing evidence and best practices for multimorbid adults in most primary care offices.
This perspectives piece sets forth a research agenda in the area of implementation science at the intersection of geriatrics and general internal medicine. We challenge academic medical centers, medical societies, journals, and funders to actively value and support investigation in this area as much as traditional research pathways. As our population ages and accumulates a mounting burden of chronic illness and functional decline, primary care clinicians who provide most of the care for this population 1 are faced with growing complexity and a need for increased skills in multimorbidity, prognosis, goal setting, and team-based care.
Further, most guidelines address one condition and not the interaction between multiple comorbidities, so primary care clinicians find it harder to practice evidence-based medicine in an era when pay-for-performance is becoming commonplace. Moreover, with the growth of multiple chronic conditions MCCs in adults of all ages, expertise in cognitive impairment, functional decline, and other traditional geriatric issues expands beyond the population greater than 65 years of age.
To help bridge the gaps in providing optimal care to multimorbid adults, we will: 1 consider the geriatrics framework for care of older adults; 2 identify geriatric team-based care models that successfully coordinate services between the healthcare system and community resources and that could be expanded throughout primary care; and 3 highlight how dissemination and implementation science is a growing field that can address the challenges of putting such models into place to the benefit of all patients with complex health problems.
Geriatrics has long championed patient-centered care that first optimizes function and independence, paying careful attention to patient and family goals of care in a relationship-based and whole-person oriented approach, 3 a care model that is extremely important for adults with multiple comorbidities and the frail elderly. Many older people have unrecognized functional limitations, and by bringing these to light, we allow for a more patient-centered approach, setting meaningful and realistic goals for each patient and their family support structure.
