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Cho C, Bak G, Sumpton D, Richards B, Sherrington C. Perspectives of healthcare providers on osteoporosis, falls and fracture risk: a systematic review and thematic synthesis of qualitative studies. Arch Osteoporos 2024; 19:90. [PMID: 39313605 PMCID: PMC11420259 DOI: 10.1007/s11657-024-01446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE Osteoporosis and falls are major risk factors for osteoporotic fractures, with significant detriment to patients' quality of life. We aimed to describe healthcare provider (HCP) perspectives and experiences in the diagnosis, management and prevention of osteoporosis, falls and fractures obtained through primary qualitative research. METHODS Thematic synthesis was performed on articles identified through a search of electronic databases (MEDLINE, Embase, PsychINFO and CINAHL), which were searched from inception to May 2023. RESULTS Twenty-seven studies including 1662 HCPs, including general practitioners (GPs), physicians, surgeons, physiotherapists (PTs), occupational therapists (OTs), pharmacists and nurses, were included, with identification of six themes: overshadowed as a disease entity, uncertainty in decision making, frustration with interdisciplinary and systemic tension, avoiding medical paternalism, desire for improved care and embracing the responsibility. CONCLUSION Osteoporotic fracture and fall prevention in routine clinical care is hampered by inadequate priority and lack of perceived connection with morbidity and mortality, deficits in interdisciplinary collaboration, lack of clinical confidence and health resourcing. However, HCPs acknowledge their role in promoting healthy ageing, thus providing support through appropriate continuing education, resourcing and public health campaigns that are significant future directions, which may improve osteoporotic fracture prevention.
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Affiliation(s)
- Catherine Cho
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia.
- The Institute of Musculoskeletal Health, Sydney, Australia.
- Concord Repatriation General Hospital, Sydney, Australia.
| | - Grace Bak
- Concord Repatriation General Hospital, Sydney, Australia
| | - Daniel Sumpton
- Concord Repatriation General Hospital, Sydney, Australia
| | - Bethan Richards
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia
- The Institute of Musculoskeletal Health, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Catherine Sherrington
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia
- The Institute of Musculoskeletal Health, Sydney, Australia
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Vandervelde S, Van den Bosch N, Vlaeyen E, Dierckx de Casterlé B, Flamaing J, Belaen G, Tuand K, Vandendriessche T, Milisen K. Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community- dwelling older people: a systematic review. Age Ageing 2024; 53:afae123. [PMID: 38952187 DOI: 10.1093/ageing/afae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation. METHODS A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. 'The Comprehensive Integrated Checklist of Determinants of practice' was used to categorise the determinants. RESULTS Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives. CONCLUSIONS Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.
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Affiliation(s)
- Sara Vandervelde
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Natalie Van den Bosch
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Ellen Vlaeyen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, 3590 Diepenbeek, Belgium
| | - Bernadette Dierckx de Casterlé
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Johan Flamaing
- KU Leuven, Department of Public Health and Primary Care, Gerontology and Geriatrics, Kapucijnenvoer 7 bus 7001 3000 Leuven, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
| | - Goedele Belaen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Krizia Tuand
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Vandendriessche
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Koen Milisen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
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Sun W, Wang P, Zhao Y. The characteristics of the body mass frequency index in dysmobility syndrome: A pilot study. Exp Gerontol 2024; 191:112414. [PMID: 38570056 DOI: 10.1016/j.exger.2024.112414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND With the advancement of global aging, there has been an increase in patients with dysmobility syndrome (DS), often accompanied by osteoporosis, sarcopenia, and sarcopenic obesity. The objective of this study was to evaluate the application value of the body mass frequency index (BMFI) in older patients with DS by comprehensively analyzing the differences in BMFI between community-dwelling older subjects using medical and engineering methods. METHODS A cross-sectional study was conducted to recruit community-dwelling older subjects aged 60-90 years. Various assessments and measurements were performed, including basic information collection, gait analysis, bone mineral density (BMD) and body composition measurement, fall and fracture risk et al. Gait analysis and body mass index (BMI) are in the established model to calculate BMFI. Analysis of BMFI was performed in community-dwelling older subjects, and the specificity and threshold of BMFI in predicting dysmobility syndrome (DS) were further analyzed. RESULTS Significant differences in BMFI were observed between older adults with DS and those without DS. BMFI in older people was associated with bone quality, fracture risk, body fat percentage, appendicular skeletal muscle mass index (ASMI), grip strength, and speed. The odds ratio (OR) and 95 % confidence interval (CI) for BMFI in the non-DS and DS groups were 0.823 (0.743-0.901), respectively. Receiver operating characteristic (ROC) analysis demonstrated that BMFI had predictive value in distinguishing non-DS from DS (AUC = 0.669) (P < 0.05). The optimal threshold for predicting non-DS and DS was found to be 16.04 (sensitivities = 0.483, specificities = 0.774). CONCLUSION The measurement of BMFI has demonstrated disparities in musculoskeletal status among older adults with and without DS. Notably, BMFI exhibits a unique predictive capacity for DS among the elderly population.
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Affiliation(s)
- Wen Sun
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Traditional Chinese Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai 200434, China.
| | - Peige Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Yongfang Zhao
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
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Muusse JSC, Zuidema R, van Scherpenseel MC, Velde SJT. Influencing factors of interprofessional collaboration in multifactorial fall prevention interventions: a qualitative systematic review. BMC PRIMARY CARE 2023; 24:116. [PMID: 37193995 DOI: 10.1186/s12875-023-02066-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND With the ageing population worldwide, falls are becoming a severe and growing health problem. Interprofessional multifactorial fall prevention interventions (FPIs) have effectively prevented falls in community-dwelling older adults. However, the implementation of FPIs often fails due to a lack of interprofessional collaboration. Therefore, gaining insight into the influencing factors of interprofessional collaboration in multifactorial FPI's for older adults living in the community is essential. Consequently, our aim was to provide an overview of factors influencing interprofessional collaboration in multifactorial FPIs for community-dwelling older adults. METHODS This qualitative systematic literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Pubmed, CINAHL, and Embase electronic databases have been systematically searched for eligible articles, with a qualitative design. The quality was appraised using the Checklist for Qualitative Research by the Joann Briggs Institute. The findings were inductively synthesized using a meta-aggregative approach. Confidence in the synthesized findings was established using the ConQual methodology. RESULTS Five articles were included. Analysis of the included studies resulted in 31 influencing factors for interprofessional collaboration, which were labelled as findings. These findings were summarized in ten categories and combined into five synthesized findings. Results showed that communication, role clarity, information sharing, organization, and interprofessional aim influence interprofessional collaboration in multifactorial FPIs. CONCLUSIONS This review provides a comprehensive summary of findings on interprofessional collaboration, specifically in the context of multifactorial FPIs. Knowledge in this area is considerably relevant given the multifactorial nature of falls, which demands an integrated, multidomain approach, including both health and social care. The results can be utilized as a fundament for developing effective implementation strategies aiming to improve interprofessional collaboration between health and social care professionals working in multifactorial FPIs in the community.
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Affiliation(s)
- J S C Muusse
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - R Zuidema
- Research Centre for Healthy and Sustainable Living, Research Group Proactive Care for Elderly People Living at Home, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - M C van Scherpenseel
- Research Centre for Healthy and Sustainable Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - S J Te Velde
- Research Centre for Healthy and Sustainable Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
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Diagnostic dependence of muscle strength measurements and the risk of falls in the elderly. Int J Rehabil Res 2021; 43:330-336. [PMID: 32784331 DOI: 10.1097/mrr.0000000000000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Low muscle strength appears to increase balance disorders and the tendency to fall. Diagnostic terms indicate that sarcopenia and risks of falling are related. The aim of this study is to verify which diagnostic tools used for the assessment of muscle strength in sarcopenia can be used for fall risk assessment in older women. The study included 56 females [71.77 ± 7.43(SD)]. The results of handgrip strength (HGS) and knee extensors torque [knee extension strength (KES)] were compared to the results of stabilographic parameters from Biodex Balance System platform in static and dynamic environment. The one-way ANOVA and Pearson correlation were performed. There were significant differences between groups with low and normal HGS in the chair test, and between groups with low and normal KES in the fall risk index, FRI12-6 and chair test (P < 0.05). Static parameters did not differentiate groups, due to a muscle strength of the upper and lower limbs. There was a statistically significant difference in FRI12-6 values between participants with low and normal KES in age groups (P = 0.047). No differences were found in FRI12-6 values between participants with low and normal HGS in age groups (P = 0.949). Statistical analysis showed differences in FRI12-6 between fallers with low KES and non-fallers with normal KES, non-fallers with low KES and non-fallers with normal KES. Results of the study show that there is diagnostic dependence in muscle strength of lower limbs and risk of falls in older women. KES and chair test can be used in fall risk assessment for older women.
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Selected Tools for Assessing the Risk of Falls in Older Women. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2065201. [PMID: 33274197 PMCID: PMC7683108 DOI: 10.1155/2020/2065201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022]
Abstract
Methods Fifty-five females were examined (May 2018-June 2019). Stabilographic examinations were performed with eyes open (EO) and closed (EC). An analysis of variance (ANOVA) and Spearman rank correlation were performed to determine the relationships and differences between the above tests. Results The results of the TUG correlate with the overall stability index (OSI) EO (r = 0.314), medial-lateral stability index (MLSI) EO (r = 0.297), and fall risk index (FRI6-2; r = 0.435) in stabilographic examinations and the FRT (r = −0.399). The results of the modified Unterberger test correlate with MLSI EO (r = 0.276), OSI EC (r = 0.310), and MLSI EC (r = 0.378). There are statistically significant differences between faller and nonfaller groups in TUG (p = 0.0068), FRT (p = 0.001), and MLSI EO (p = 0.0118). Conclusions The modified Unterberger test and TUG can be considered effective in functional FR assessment in older women. Using at least two different functional tests may improve the assessment of FR.
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Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Otago exercise programme-from evidence to practice: a qualitative study of physiotherapists' perceptions of the importance of organisational factors of leadership, context and culture for knowledge translation in Norway. BMC Health Serv Res 2020; 20:985. [PMID: 33109177 PMCID: PMC7590709 DOI: 10.1186/s12913-020-05853-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Falls and fall-related injuries are a major public health problem and an international priority for health services. Despite research showing that evidence-based fall prevention is effective, its translation into practice has been delayed and limited. Although organisational factors such as leadership, culture and context are key factors for implementing evidence-based practice, there is still limited information on whether these factors represent barriers in the Norwegian and international healthcare context. Thus, this study aimed to explore the views of physiotherapists in clinical practice and their leaders’ views on the importance of organisational factors, such as leadership, culture and contextual and human resources, regarding successful knowledge translation of the Otago evidence-based fall programme in a Norwegian community. Methods Four in-depth interviews with physiotherapists and a focus group interview with nine physiotherapists and leaders representing local hospitals and municipalities were conducted to collect data. The data were analysed using a thematic analysis. Results The analysis yielded an overarching theme: an empowering leader as an anchor is needed for successful knowledge translation of physiotherapists’ and leaders’ views about the role of organisational structure, leadership, culture, financial resources and competence in research-based knowledge, as well as how to enhance the clinical staff’s expertise. Four main themes further elaborated on the overarching theme: (1) multifactor leadership—the importance of reinforcement, knowledge, goals and attention; (2) potential for change in professional roles as shaped by culture, context and type of practice; (3) knowledge translation—the tension between real-life capabilities, optimism and learning; and (4) different types of support—environmental resources and social influences. Conclusions This study highlighted the importance of organisational factors in knowledge translation in fall prevention. The findings emphasise the importance of leaders’ role and style in providing a supportive culture and contextual factors during the knowledge translation process. This study provides an understanding of the knowledge translation and sustainability of evidence-based practice and the Otago exercise programme for fall prevention programmes for community-dwelling older adults in Norway. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05853-8.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
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Lee JQ, Loke W, Ng QX. The Role of Family Physicians in a Pandemic: A Blueprint. Healthcare (Basel) 2020; 8:healthcare8030198. [PMID: 32635633 PMCID: PMC7551144 DOI: 10.3390/healthcare8030198] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Pandemics are a significant stress test for a country’s economic, political and health systems. An effective pandemic response demands a multi-pronged and multi-layered approach, comprising surveillance, containment, border control, as well as various social and community measures. In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic, which has now infected more than 7 million people worldwide, strict quarantine measures are a commonplace, and a third of the world’s population have now gone into some form of lockdown. With the exception of border control, all these response measures involve the contributions of family physicians and general practitioners (GPs) in one way or another. Primary care physicians form and lead the primary care network, which in turn forms the backbone of any healthcare system. Being the first point of contact for a significant proportion of patients, primary care physicians play an essential strategic function in the fight against disease, both during peacetime and in the event of a public health crisis. In this commentary, we examine and propose some of the key roles that they play in a pandemic, drawing examples from the current COVID-19 pandemic and past experiences. COVID-19 has showed us that the world is grossly unprepared for a pandemic, both in terms of our global management and the structure of our current primary health care systems, and this should provide the impetus for us to improve.
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Affiliation(s)
- Jie Qi Lee
- NTU Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore 308232, Singapore;
| | - Wayren Loke
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore;
| | - Qin Xiang Ng
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore;
- Correspondence: ; Tel.: +65-6638-6979
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Mackenzie L, Clemson L, Irving D. Fall prevention in primary care using chronic disease management plans: A process evaluation of provider and consumer perspectives. Aust Occup Ther J 2019; 67:22-30. [PMID: 31682030 DOI: 10.1111/1440-1630.12618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Falls are an important issue in primary care. General practitioners (GPs) are in a key position to identify older people at risk of falls on their caseload and put preventative plans into action. Chronic Disease Management (CDM) plans allow GPs to refer to allied health practitioners (AHPs) for evidence-based falls interventions. A previous pilot study reduced falls risk factors using CDM pans with older people at risk of falls. This study aimed to conduct a process evaluation of how the intervention worked in the pilot study for providers and consumers. METHODS This process evaluation used qualitative descriptive methods by interviewing the GPs, AHPs and older people involved in the intervention study. An independent researcher conducted interviews. These were audiotaped, transcribed and analysed using thematic analysis. Data were also collected about the implementation of the programme. RESULTS Two GPs, three occupational therapists, three physiotherapists and eight older people were interviewed. Key themes emerged from the perspectives of providers and consumers. The programme was implemented as intended, adherence to the exercise diaries was variable and the falls calendars were fully completed for three months of follow-up. The programme was implemented as intended. CONCLUSION The pilot CDM falls prevention programme did not identify common barriers attributed to GPs. Older people were amenable to the programme and participated freely. Private AHPs needed to make the CDM items work for their business model. This approach can be rolled out in a larger study and integrated pathways are needed to identify and intervene with older people at risk of falls in primary care.
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Affiliation(s)
- Lynette Mackenzie
- Faculty of Health Sciences, Discipline of Occupational Therapy, The University of Sydney, Lidcombe, NSW, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, Physical Activity, Lifestyle, Ageing and Work Research Group, The University of Sydney, Lidcombe, NSW, Australia
| | - Diana Irving
- Faculty of Health Sciences, Discipline of Occupational Therapy, The University of Sydney, Lidcombe, NSW, Australia
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Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists' views on the Otago exercise Programme. BMC Geriatr 2019; 19:278. [PMID: 31638912 PMCID: PMC6805671 DOI: 10.1186/s12877-019-1309-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists' views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention. METHODS We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis. RESULTS The analysis yielded two main themes: the researcher's role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding. CONCLUSIONS Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurobiology, Health Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Mackenzie L, McIntyre A. How Do General Practitioners (GPs) Engage in Falls Prevention With Older People? A Pilot Survey of GPs in NHS England Suggests a Gap in Routine Practice to Address Falls Prevention. Front Public Health 2019; 7:32. [PMID: 30915322 PMCID: PMC6421941 DOI: 10.3389/fpubh.2019.00032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/06/2019] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Lynette Mackenzie
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Anne McIntyre
- Occupational Therapy, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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Burgon C, Darby J, Pollock K, van der Wardt V, Peach T, Beck L, Logan P, Harwood RH. Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study. BMJ Open 2019; 9:e025702. [PMID: 30755449 PMCID: PMC6377506 DOI: 10.1136/bmjopen-2018-025702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia. DESIGN This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis. SETTING Community-based falls and memory assessment services in the East Midlands, UK. PARTICIPANTS Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1). RESULTS Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients' poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia. CONCLUSIONS Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
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Affiliation(s)
- Clare Burgon
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Janet Darby
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Veronika van der Wardt
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Lyndsay Beck
- Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan H Harwood
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Health Care of Older People, Nottingham, UK
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van Rhyn B, Barwick A. Health Practitioners' Perceptions of Falls and Fall Prevention in Older People: A Metasynthesis. QUALITATIVE HEALTH RESEARCH 2019; 29:69-79. [PMID: 30311840 DOI: 10.1177/1049732318805753] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fall prevention has received a great deal of consideration and funding, however fall rates have not reduced accordingly. Health practitioners are key stakeholders in the process of implementing fall prevention evidence into their clinical assessment and management of older people at risk of falling. Investigating health practitioners' clinical experiences and perceptions has been identified as a means to enhance the translation of knowledge. Four databases were searched for studies exploring health practitioners' perceptions of falls and fall prevention. A metasynthesis of eight qualitative studies was conducted. The findings suggest that health practitioners face substantial barriers in the implementation of fall prevention practices. These include personal, interpersonal, and clinical barriers in addition to limitations of the research evidence. This knowledge hopes to enhance targeted dissemination of knowledge, reducing the research-practice gap and improving clinical outcomes for older people at risk of falls.
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Affiliation(s)
| | - Alex Barwick
- 1 Southern Cross University, Bilinga, Queensland, Australia
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14
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Mackenzie L, Clifford A. Perceptions of primary health staff about falls prevention in primary care settings in the west of Ireland. Br J Occup Ther 2018. [DOI: 10.1177/0308022618761759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Primary care is an emerging area of practice for allied health practitioners. The effective integration of primary care services provided by different professions using diverse funding sources is challenging. Ireland has implemented a primary care strategy and set up primary care teams to address this. Acknowledging the ageing population in the community, fall prevention needs to be a core function of these services. This study aimed to explore the perceptions of general practitioners, occupational therapists and physiotherapists working in the primary care setting about falls prevention in their practice. Method Three general practitioners, five occupational therapists and three physiotherapists were interviewed from primary care teams in the counties of Limerick, Clare and North Tipperary, Ireland. Interviews were in person or by telephone and audiotaped, transcribed and analysed thematically. Results Two key themes emerged from the data: the level of primary care team integration and the nature of community fall prevention, linked by referral mechanisms. Conclusion Providing comprehensive falls prevention services in the primary care context is complex. Integrated processes and pathways in primary care teams are needed to identify older people at risk of falls and to engage a whole of primary care approach to fall prevention.
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Affiliation(s)
- Lynette Mackenzie
- Associate Professor, Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Amanda Clifford
- Senior Lecturer in Physiotherapy, Department of Clinical Therapies, University of Limerick, Limerick, Republic of Ireland
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15
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Liddle J, Lovarini M, Clemson L, Mackenzie L, Tan A, Pit SW, Poulos R, Tiedemann A, Sherrington C, Roberts C, Willis K. Making fall prevention routine in primary care practice: perspectives of allied health professionals. BMC Health Serv Res 2018; 18:598. [PMID: 30075774 PMCID: PMC6091062 DOI: 10.1186/s12913-018-3414-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background 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. Methods 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. Results We found fall prevention was valued in practice and recognised as complex. AHPs worked through challenges relating to clients (multi-morbidity, complex living situations, client motivation), challenges working alongside other health professionals (understanding respective roles/overlapping roles, sense of competition, communication) and challenges associated with funding systems perceived as complicated and constantly changing. Despite these challenges, AHPs were adopting strategies for integrating fall prevention routinely. The iSOLVE workshops were perceived as important in supporting existing practice and in providing strategies to enhance practice. Conclusions Policy makers, program managers, educators and AHPs can adopt strategies identified in this research for routinising fall prevention such as being alert that falls are common, asking every client about falls, having processes for assessing clients for fall risk, and having structured and evidence-based programs to work with clients on fall prevention. Adapting and streamlining funding systems are also important for facilitating fall prevention work.
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Affiliation(s)
- Jeannine Liddle
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia.
| | - Meryl Lovarini
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Lynette Mackenzie
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Amy Tan
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Sabrina W Pit
- University Centre for Rural Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Roslyn Poulos
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anne Tiedemann
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Chris Roberts
- Sydney Medical School - Northern, The University of Sydney, Sydney, NSW, Australia
| | - Karen Willis
- Melbourne Health, La Trobe University, Parkville, VIC, Australia
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Mackenzie L, Lovarini M, Price T, Clemson L, Tan A, O’Connor C. An evaluation of the fall prevention practice of community-based occupational therapists working in primary care. Br J Occup Ther 2018. [DOI: 10.1177/0308022618764798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lynette Mackenzie
- Associate Professor, Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Meryl Lovarini
- Lecturer, Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Thomas Price
- MOT graduate, Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Professor, Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Amy Tan
- Research Manager iSOLVE project, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Claire O’Connor
- Reablement in Dementia Fellow, HammondCare, Hammondville, New South Wales, Australia
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Grol SM, Molleman GRM, Kuijpers A, van der Sande R, Fransen GAJ, Assendelft WJJ, Schers HJ. The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care. BMC FAMILY PRACTICE 2018; 19:40. [PMID: 29523092 PMCID: PMC5845178 DOI: 10.1186/s12875-018-0726-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the western world, a growing number of the older people live at home. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. However, little is known about how GPs can play this role best. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. METHODS A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. Moreover, we performed semi-structured interviews with four GPs. We analysed data using a hybrid inductive/deductive thematic analysis. RESULTS According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to 'see the bigger picture'. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. According to team members, GPs were the central professionals in care services for older people. The opinions of GPs about their own roles were diverse. CONCLUSIONS GPs took an important role in successful care settings for older people. Five key concepts seemed to be important for best practices in care for frail older people: networking (community), facilitating (organization), team building (professional), integrating care elements (patient), and leadership (personal). Team members from primary care and social services indicated that GPs had an indispensable role in such teams. It would be advantageous for GPs to be aware of this attributed role. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people.
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Affiliation(s)
- Sietske M. Grol
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Gerard R. M. Molleman
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Healthy Living, Community Health Service Gelderland-Zuid, POB 1120, 6501 BC Nijmegen, the Netherlands
| | - Anne Kuijpers
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Rob van der Sande
- Lectureship of primary and community care, Han University of Applied Sciences, POB 6960, 6503 GL Nijmegen, the Netherlands
| | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Healthy Living, Community Health Service Gelderland-Zuid, POB 1120, 6501 BC Nijmegen, the Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Henk J. Schers
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
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18
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Kielich K, Mackenzie L, Lovarini M, Clemson L. Urban Australian general practitioners' perceptions of falls risk screening, falls risk assessment, and referral practices for falls prevention: an exploratory cross-sectional survey study. AUST HEALTH REV 2018; 41:111-119. [PMID: 27096324 DOI: 10.1071/ah15152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
Objective The study aimed to explore Australian general practitioners' (GPs) perceptions of falls risk screening, assessment and their referral practices with older people living in the community, and to identify any barriers or facilitators to implementing evidence-based falls prevention practice. Methods Hardcopy surveys and a link to an online survey were distributed to 508 GPs working at one Medicare Local (now part of a Primary Care Network) located in Sydney, Australia. Data were analysed using descriptive statistics and key themes were identified from open text responses. Results A total of 37 GPs returned the survey. Only 10 (27%) GPs routinely asked older people about falls, and five (13.5%) asked about fear of falls during clinical consultations. Barriers to managing falls risk were identified. GPs estimated that they made few referrals to allied health professionals for falls interventions. Conclusions GPs were knowledgeable about falls risk factors but this did not result in consistent falls risk screening, assessment or referral practices. Due to the small sample, further research is needed with a larger sample to augment these results. What is known about the topic? Falls are a common and serious health issue for older people and fall prevention is vital, especially in the primary care setting. General practitioners (GPs) are key health professionals to identify older people at risk of falls and refer them to appropriate health professionals for intervention. Evidence-based falls prevention interventions exist but are not easily or routinely accessed by older people. What does this paper add? GPs believe that previous falls are an important falls risk factor but they do not routinely ask about falls or fear of falls in clinical practice with older people. GP referral rates to allied health professionals for falls prevention are low, despite evidence-based falls prevention interventions being provided by allied health professionals. There are several barriers to GPs providing falls prevention assessment and intervention referrals, particularly using the current primary health systems. What are the implications for practitioners? GPs need to recognise their potential significant contribution to falls prevention in the community and may require tailored training. Sustainable evidence-based referral pathways need to be developed so that older people can be referred to allied health professionals for falls prevention interventions in the primary care setting, and better local networks need to be developed to allow this to occur. Policy makers may have to address the identified barriers to multidisciplinary practice and funding of services to facilitate effective falls prevention programs in primary care.
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Affiliation(s)
- Kajtek Kielich
- Ageing Work and Health Research Unit, Faculty of Health Sciences, 75 East Street, University of Sydney, Lidcombe, NSW 2141, Australia.
| | - Lynette Mackenzie
- Ageing Work and Health Research Unit, Faculty of Health Sciences, 75 East Street, University of Sydney, Lidcombe, NSW 2141, Australia.
| | - Meryl Lovarini
- Ageing Work and Health Research Unit, Faculty of Health Sciences, 75 East Street, University of Sydney, Lidcombe, NSW 2141, Australia.
| | - Lindy Clemson
- Ageing Work and Health Research Unit, Faculty of Health Sciences, 75 East Street, University of Sydney, Lidcombe, NSW 2141, Australia.
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19
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Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. AUST HEALTH REV 2017; 41:144-150. [PMID: 27333204 DOI: 10.1071/ah16054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Affiliation(s)
- Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Michele Foster
- School of Social Work and Human Services, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
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20
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Romli MH, Tan MP, Mackenzie L, Lovarini M, Kamaruzzaman SB, Clemson L. Factors associated with home hazards: Findings from the Malaysian Elders Longitudinal Research study. Geriatr Gerontol Int 2017; 18:387-395. [DOI: 10.1111/ggi.13189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Muhammad H Romli
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences; University Putra Malaysia; Serdang Malaysia
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus; University of Sydney; Sydney New South Wales Australia
| | - Maw P Tan
- Aging and Age Associated Disorders Research Group, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus; University of Sydney; Sydney New South Wales Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus; University of Sydney; Sydney New South Wales Australia
| | - Shahrul B Kamaruzzaman
- Aging and Age Associated Disorders Research Group, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Lindy Clemson
- Discipline of Occupational Therapy, Faculty of Health Sciences, Cumberland Campus; University of Sydney; Sydney New South Wales Australia
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