A study to assess the scalability of an integrated falls prevention service for community-dwelling older people

Problem

The scaling up of interventions delivered in healthcare settings is a growing area in implementation research. Increasingly, the need for a phased approach is acknowledged, beginning with an assessment of ‘scalability’, defined as the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of an integrated falls prevention service across primary and secondary care in southwest Ireland and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT).

Approach

A variety of methods was used sequentially, in line with the ISAT guidance: a review of existing service data on implementation and of falls-related literature and policy documents; one-to-one interviews with key stakeholders (n=11) involved in managing the service; and an online questionnaire with stakeholders to rate scalability and provide further feedback.

Findings

Most participants believed that the issue of falls among older people was of sufficient priority to warrant scale up of the service and that the service aligned with the health policy context in terms of prioritising falls prevention. However, considerable barriers to scale up were cited, including insufficient resources, particularly personnel, and the need for an integrated electronic patient management system linking primary and secondary care.

Consequences

Notwithstanding senior management support for scaling up this service, the current scalability is questionable given the barriers that need to be addressed. Improved resourcing and ensuring that the service is more fully embedded into primary care are among the recommendations to enable future scale up of this falls prevention service to other regions in the country.