A Framework for Expectations of Physician Commitment in Long-Term Care Homes: A Consensus Statement.

OBJECTIVES

Our objective was to establish consensus-guided expectations for primary care physician (PCP) commitment in Canadian long-term care (LTC) homes, developing a comprehensive framework for this multifaceted concept.

DESIGN

This was a 2-round modified e-Delphi study with a virtual consensus meeting between rounds.

SETTING AND

PARTICIPANTS

Twenty-seven Canadian LTC PCPs as expert panelists (63% female; median age, 54 years; median 15 years of LTC experience) were included.

METHODS

Panel members rated 38 candidate statements on relevance and feasibility using a 7-point scale, providing qualitative feedback in an online questionnaire. Consensus was defined a priori as ≥70% of panelists rating a statement in a particular direction. Nonconsensus statements in round 1 were revised and reevaluated in round 2 after the virtual meeting (study registration number: ISRCTN35125526).

RESULTS

In round 1, 18 statements were endorsed as relevant and feasible expectations for PCP commitment. After the virtual meeting, 22 statements were rated in round 2, yielding 3 additional consensus statements. The final 21 endorsed statements encompassed the following: time allocated in LTC, in-person visits and on-site presence, number of residents cared for, assessments and care conferences, interdisciplinary collaboration, accessibility of PCP to staff, emphasis on medical care approaches for medication management and palliative care principles, and ongoing competency development. The panel did not endorse statements focused on the number of LTC homes a PCP serves, cumulative experience, specialized certifications, clinical leadership, or research activities as essential to commitment.

CONCLUSIONS AND IMPLICATIONS: This first consensus-based framework for PCP commitment in Canadian LTC provides a clear, evidence-informed, multidimensional understanding, enhancing our ability to characterize and quantify physician involvement in LTC. This framework is crucial for enhancing care quality in the LTC sector, guiding policies and practices, influencing minimum care standards, and addressing health human resources while supporting future research linking PCP commitment to resident health outcomes and developing measurement tools to assess physician commitment in LTC.