Fall prevention in primary care using chronic disease management plans: A process evaluation of provider and consumer perspectives (original) (raw)
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Making fall prevention routine in primary care practice: perspectives of allied health professionals
BMC health services research, 2018
While there is strong evidence that fall prevention interventions can prevent falls in people aged 65 and over, translating evidence into routine practice is challenging. Research regarding how allied health professionals (AHPs) respond to this challenge is limited. As part of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project, this study aimed to explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice. In-depth qualitative interviews were conducted with fifteen AHPs who had attended evidence-based workshops associated with the iSOLVE project. AHPs had backgrounds in physiotherapy, occupational therapy, exercise physiology and podiatry. Interviews explored how fall prevention was being incorporated into routine practice and the factors that influenced routinisation, including the project workshops. Thematic analysis was used to analyse the data. We found fall prevention was va...
Frontiers in Public Health
Falls are highly prevalent amongst older people and have substantial financial and social costs for health services and the community. Prevention of falls is the key to managing this threat to older people. General practitioners can identify older people at risk of falls on their caseloads. Once identified, actions can be taken to reduce the risk of falls by referring to appropriate services available in the community, such as allied health practitioners. However, the level of engagement in evidence based falls prevention by GPs is unknown. This study aimed to explore how British general practitioners (GPs) address falls prevention with older people, and to determine if there are any gaps in practice. As a pilot study, another aim was to test the feasibility of methods to survey GPs, if a larger survey was warranted from the findings. An on-line cross-sectional survey was distributed by email to all the Clinical Commissioning Groups in NHS England (n = 213) and individual general practices listed on the NHS Choices website, supplemented by invitations distributed to CCGs through Twitter and LinkedIn sites. Thirty-seven responses were received. Most GPs were unfamiliar with the 2013 NICE guidelines on assessment and prevention of falls in older people (51.4%, n = 19), and only 29.7% (n = 11) asked older people if they had fallen during consultations. If falls risk was identified, 81.1% (n = 30) frequently made referrals to physiotherapy (PT) and 56.8% (n = 21) to occupational therapy (OT). Most GPs did not identify older people on their caseloads as being at risk of falls unless they presented with a fall, and referral rates to relevant AHPs or falls prevention programs were low. Barriers to implementation of falls prevention best practice were identified. Alternative methods are needed to capture the falls prevention practice of a wider sample of GPs.
Falls Preventionand General Practice
length: 155 Number of References: 37 Abstract Objective: To identify how general practitioners (GPs) address falls prevention in their everyday practice with older people living in the community. Method: A cross sectional survey distributed to metropolitan GPs via Medicare Local medical database. Results: Most GPs did not ask about falls (68.75%) or fear of falls (84.38%) routinely during clinical consultations. The most common barriers to routine falls screening and Chronic Disease Management plans (CDM) or Team Care Arrangements (TCA) were patients' more immediate demands and time constraints. Some GPs had substantially greater referral rates to AHPs. Physiotherapists and Occupational therapists were considered most necessary for effective falls interventions and were the most common allied health professionals (AHPs) referred to by GPs.
Fall Prevention in a Primary Care Setting
Deutsches Arzteblatt international, 2016
Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. In the intervention group (n=222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care ...
Engagement of general practitioners in falls prevention and referral to occupational therapists
British Journal of Occupational Therapy
Introduction: Falls prevention is a key activity for general practitioners, occupational therapists and other allied health professionals. Despite evidence for multidisciplinary community-based interventions, uptake of falls prevention is variable. General practitioners are crucial in identifying older people at risk of falls and referring for intervention. This research aims to identify the current practice of general practitioners in falls prevention and to identify opportunities for occupational therapists in particular to extend their role in falls prevention in primary care. Method: A total of 4000 paper surveys were mailed to randomly selected general practitioners within 209 clinical commissioning groups in England. Online surveys were also distributed via clinical commissioning groups to approximately 3200 general practitioners. Descriptive analysis of the data was undertaken. Results: A total of 152 general practitioners responded. More than half indicated they were familiar with the UK guidelines for falls risk screening, but less than a third implemented these. Only 31% routinely asked older people if they had fallen. Whilst 90% identified occupational therapists as providing evidence-based falls prevention, only 74% referred to occupational therapy. Conclusion: There are gaps in general practitioners' falls prevention referral practices to occupational therapists and allied health professionals. Better general practitioner pathways could enhance the quality of falls-prevention care for older people at risk.
Journal of Evaluation in Clinical Practice, 2010
Rationale, aims and objectives The incidence of falls and fall-related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall-related injuries, a considerable gap remains between best practice and current health service delivery. This paper describes the method and results of the implementation and evaluation of a state-wide workforce enhancement strategy to promote the uptake of evidence-based falls prevention activities for older people. Methods The project was undertaken in Queensland, Australia in 2008 across the community, acute and residential aged care sectors. Six Falls Safety Officers (FSOs) were appointed to implement a 1-year pilot of strategies aimed at enhancing workforce capacity to deliver a coordinated approach to falls prevention across the care continuum. The project was independently evaluated for process, impact and outcome. Both quantitative and qualitative data were extracted from records maintained by the FSOs for the evaluation and additional data were obtained from interviews with key stakeholders. Results Considerable progress was achieved towards the project's objectives, including the wide dissemination of information and resources, as well as the establishment of working groups to continue falls prevention planning and implementation. Barriers and facilitators to the project's implementation were identified. Conclusion The formal evaluation provides evidence for the development of a crosscontinuum service delivery model for implementing coordinated state-wide falls prevention strategies for the prevention of falls in older people.
The Gerontologist
Background and Objectives Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this article is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. Research Design and Methods This evaluation used mixed methods. Qualitative evaluation involved semistructured interviews with key stakeholders and intercept interviews with health care providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework...
Frontiers in public health, 2015
Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention's (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers' beliefs, knowledge, and fall-related activities before they received training on h...