scholarly journals Implementation of systematic fall risk screening in primary care: barriers and facilitators

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W M A Meekes ◽  
C J Leemrijse ◽  
J C Korevaar ◽  
L A M van de Goor
Keyword(s):  
Primary Care ◽  
Older People ◽  
Fall Prevention ◽  
Fall Risk ◽  
Barriers And Facilitators ◽  
Risk Screening ◽  
Systematic Screening ◽  
Underlying Causes ◽  
Fall Risk Screening ◽  
Adequate Communication

Abstract Background Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting. Methods The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved. Preliminary results Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice. Conclusions Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently. Key messages Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.

scholarly journals Implementing a Clinically Based Fall Prevention Program

2017 ◽  
Vol 14 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Judy A. Stevens ◽  
Matthew Lee Smith ◽  
Erin M. Parker ◽  
Luohua Jiang ◽  
Frank D. Floyd
Keyword(s):  
Primary Care ◽  
Staff Training ◽  
Fall Prevention ◽  
Fall Risk ◽  
New York State ◽  
Primary Care Providers ◽  
York State Department ◽  
Care Providers ◽  
Risk Screening ◽  
Fall Risk Screening

Introduction. Among people aged 65 and older, falls are the leading cause of both fatal and nonfatal injuries. The burden of falls is expected to increase as the US population ages. The Centers for Disease Control and Prevention (CDC) developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to help primary care providers incorporate fall risk screening, assessment of patients’ modifiable risk factors, and implementation of evidence-based treatment strategies. Methods. In 2010, CDC funded the New York State Department of Health to implement STEADI in primary care sites in selected communities. The Medical Director of United Health Services championed integrating fall prevention into clinical practice and oversaw staff training. Components of STEADI were integrated into the health system’s electronic health record (EHR), and fall risk screening questions were added to the nursing staff’s patient intake forms. Results. In the first 12 months, 14 practices saw 10 702 patients aged 65 and older. Of these, 8457 patients (79.0%) were screened for fall risk and 1534 (18.1%) screened positive. About 52% of positive patients completed the Timed Up and Go gait and balance assessment. Screening declined to 49% in the second 12 months, with 21% of the patients screening positive. Conclusions. Fall prevention can be successfully integrated into primary care when it is supported by a clinical champion, coupled with timely staff training/retraining, incorporated into the EHR, and adapted to fit into the practice workflow.

FALL PREVENTION PRIMER FOR THE PRIMARY CARE PRACTIONER:

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Mindy Oxman Renfro, PhD, DPT, CPH, PT ◽  
Joyce Maring, EdD, DPT, PT ◽  
Donna Bainbridge, EdD, PT, AT-Ret
Keyword(s):  
Primary Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
Hospital Readmissions ◽  
Screening Tools ◽  
Evidence Based ◽  
Risk Screening ◽  
Quality Reporting ◽  
The Impact ◽  
Fall Risk Screening

<p><strong>ABSTRACT:</strong></p><p>One of three older adults age 65+ fall each year, and every 20 minutes an older adult dies due to injuries sustained during a fall.  Yet, most patients do not report falls to their physician.  Primary care practitioners (PCPs) are well positioned to screen for fall risk and add proactive referral patterns to both well-selected practitioners and evidence-based fall prevention (EBFP) programs designed to help older patients stay healthy, active, and independent.</p><p>The purposes of this review are to summarize the data related to the impact of falls; review efficient and reliable screening tools that identify individuals at high fall risk; describe appropriate referrals that facilitate a match between individual specific risk factors and interventions; and, highlight evidence-based fall prevention (EBFP) programs available to significantly decrease fall risk with outstanding return on investment.</p><p>Simple administrative changes in a PCP’s practice accompanied by appropriate referrals will result in proactive fall prevention including lower rates of falls and fall injuries and fewer hospitalizations and/or hospital readmissions. Fall risk screening can be built into practice to seamlessly add services without impacting practitioner productivity. Additionally, reporting fall risk screening and prevention activities in the Physician Quality Reporting System will positively impact practice Medicare reimbursement rates.</p>

scholarly journals A Practical and Validated Fall Risk Screening Instrument: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 233-233
Author(s):  
Wytske Meekes ◽  
J C Korevaar ◽  
C J Leemrijse ◽  
L A M van de Goor
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Older People ◽  
Fall Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Instrument ◽  
Screening Instruments ◽  
Risk Screening ◽  
Fall Risk Screening

Abstract Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC&gt;0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.

scholarly journals Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol

2020 ◽  
Vol Volume 15 ◽  
pp. 1625-1636
Author(s):  
WMA Meekes ◽  
Chantal Leemrijse ◽  
JC Korevaar ◽  
JMAE Henquet ◽  
M Nieuwenhuis ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Study Protocol ◽  
Fall Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Strategy ◽  
Risk Screening ◽  
Frail Older Adults ◽  
Fall Risk Screening

Four-item fall risk screening tool for subacute and residential aged care: The first step in fall prevention

2009 ◽  
Vol 28 (3) ◽  
pp. 139-143 ◽  
Author(s):  
Caroline Stapleton ◽  
Peter Hough ◽  
Leonie Oldmeadow ◽  
Karen Bull ◽  
Keith Hill ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Fall Risk ◽  
Screening Tool ◽  
Aged Care ◽  
Residential Aged Care ◽  
Risk Screening ◽  
Fall Risk Screening

scholarly journals Fall prevention in Dutch general practices: A descriptive study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W M A Meekes ◽  
C J Leemrijse ◽  
J C Korevaar ◽  
L A M van de Goor
Keyword(s):  
The Netherlands ◽  
Older People ◽  
Preventive Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Daily Practice ◽  
Frail Older People ◽  
Important Health ◽  
Underlying Causes

Abstract Background Falls are an important health threat among frail older people. GPs are often the first to contact for health issues and therefore they can be seen as the designated professional to offer fall prevention. At the moment, it is unknown what GPs in the Netherlands exactly do regarding fall prevention. This study aims to describe what GPs in the Netherlands do during daily practice in regards to fall prevention. Methods Thirty-four GP practices located throughout the Netherlands were followed for a period of 12 months. When a GP entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the GP received a pop-up with the question “Is this patient frail?”. If according to the GP the patient was frail, the GP subsequently completed a short questionnaire. Results About 65 GPs completed 1396 questionnaires. More than half (n = 726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF). Of 276 patients, GPs did not know if they had experienced a fall and of 408 patients if they had a FOF. Of the patients that had experienced a fall in the previous year and/or had a FOF, 37% received fall preventive care. Reasons for not offering such care were i) GP and patient did not think that the patient had a high fall risk (38%), ii) the patient finds treatment too intensive or too much of a hassle (21%) and iii) the patient was not convinced (s)he had a high fall risk and so treatment was not necessary (12%). The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. Conclusions The results show that GPs are not always aware of a patient's fall history or FOF and that only part of the patients that had experienced a fall and/or had a FOF receives fall preventive care. Hence, it is important to develop and implement strategies for GP practices to systematically screen for fall risk and to offer fall preventive care to reduce falls among frail older people. Key messages Thirty-seven percent of the frail older people that experienced a fall in the previous year and/or had a fear of falling, received fall preventive care. The three most treated underlying causes are mobility problems, fear of falling, cardiovascular factors.

scholarly journals Fall Prevention in Dutch Physician Practices: A Descriptive Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 235-235
Author(s):  
Wytske Meekes ◽  
C J Leemrijse ◽  
J C Korevaar ◽  
L A M van de Goor
Keyword(s):  
The Netherlands ◽  
Older People ◽  
Fall Prevention ◽  
Fear Of Falling ◽  
Daily Practice ◽  
Health Issues ◽  
Frail Older People ◽  
Physician Practices ◽  
Important Health ◽  
Underlying Causes

Abstract Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.

scholarly journals Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

2021 ◽  
pp. 073346482110040
Author(s):  
Lotte M. Barmentloo ◽  
Vicki Erasmus ◽  
Branko F. Olij ◽  
Juanita A. Haagsma ◽  
Johan P. Mackenbach ◽  
...  
Keyword(s):  
Fall Risk ◽  
Individual Risk ◽  
Preventive Action ◽  
Dutch Hospital ◽  
Risk Screening ◽  
Patients At Risk ◽  
Individual Risk Factors ◽  
Fall Risk Screening ◽  
Tailored Advice

Objective: We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method: Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed. Results: Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice ( n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider. Discussion: Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

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