Understanding the determinants and implementation strategies for risk of frailty management in primary care in Australia

Problem

Frailty, linked with unnecessary hospital admissions and emergency department visits, is associated with substantial health care costs. Frailty often remains undetected in primary care and recommendations are to build frailty identification and management into primary care workflows to support those patients identified as pre-frail and frail. Our early research has found that incorporating screening into the health assessment for patients aged 75 and over is a feasible and acceptable method for identifying risk of frailty in primary care, yet barriers exist to patients accessing risk of frailty management options. This study aimed to understand 1) determinants, and 2) inform strategies to implement risk of frailty management in primary care.

Approach

Using the FRAIL Scale Tool practice staff screened eligible patients (≥75 yrs) for the five frailty indices (fatigue, resistance, ambulation, illness, weight loss), referred to the associated management options, and recorded patient barriers. Semi-structured qualitative interviews were conducted with practice staff and patients to understand determinants to implementing risk of frailty management in primary care. Interview transcripts were coded deductively guided by the Consolidated Framework for Implementation Research. The thematic analysis informed ERIC implementation strategies.

Findings

The Tool was implemented by 33 general practices. Pre-frail (n=277) and frail (n=103) patients were predominantly referred for exercise interventions, medication reviews, and depression assessment. Qualitative interviews were conducted with 15 participants (n=13 practice staff, n=2 patient). Determinants of risk of frailty management implementation are related to knowledge and information about available resources, and partnerships and connection with allied health. Barriers to uptake by innovation recipients are health, cost, access, motivation, and acceptance of current state. Key implementation strategies identified are to access new funding, develop and distribute resource materials, and promote networking with local allied health.

Consequences

Identification of determinants of risk of frailty management will inform implementation strategies for primary care to support patients to reverse or reduce frailty risk.