Abstract
BackgroundFrailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework during the second stage piloting of a novel web-based tool called the Frailty Portal, developed to aid in the screening, identification, and care planning of frail patients in community PHC.MethodsThis qualitative study conducted semi-structured key informant interviews with a purposive sample of PHC providers (family physicians, nurse practitioners) and key PHC stakeholders who were administrators, decision makers and staff. The CFIR was used to guide data collection and analysis. Framework Analysis was used to determine the relevance of the CFIR constructs to implementing the Frailty Portal.ResultsA total of 17 interviews were conducted. The CFIR-inspired interview questions helped clarify critical aspects of implementation that need to be addressed at multiple levels if the Frailty Portal is to be successfully implemented in PHC. Finding were organized into three themes 1) PHC Practice Context, 2) Intervention attributes affecting implementation, and 3) Targeting providers with frail patients. At the intervention level the Frailty Portal was viewed positively, despite the multi-level challenges to implementing it in PHC practice settings. Provider participants perceived high opportunity costs to using the Frailty Portal due to changes they needed to make to their practice routines. However, those who had older patients, took the time to learn how to use the Frailty Portal, and created processes for sharing tasks with other PHC personnel become proficient at using the Frailty Portal.ConclusionsStructuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices. Incorporating CFIR constructs into evaluation instruments can flag factors likely to impede future implementation and impact the effectiveness of innovative practices. Future research is encouraged to identify how best to facilitate changes in PHC practices to address frailty and to use implementation frameworks that honor the complexity of implementing innovations in PHC.
Highlights
Frailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls
Within the assessment phase the provider is to first identify conceivably frail patients and screen those identified to determine their level of frailty using a web-based version of the Frailty Assessment for Careplanning Tool (FACT) [20], which is a modification of the Clinical Frailty Scale [21]
Despite the fact that the Consolidated Framework for Implementation Research (CFIR) is biased toward institutional care and would benefit from modifications to better capture attributes unique to primary health care (PHC), structuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices
Summary
Frailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. Frailty is often defined as a physiologic syndrome characterized by decreased reserve and resistance to stressors, resulting from a cumulative decline across multiple physiologic systems; causing vulnerability to adverse outcomes [2]. It is generally associated with multi-system (e.g., mobility, cognition, function, endurance) deterioration, and typically impacts the geriatric population. Since frailty is a robust marker of vulnerability it is important to accurately identify those who are frail, so they can be better managed with early identification and appropriate interventions that reduce adverse events [4, 5]. Routine identification and measurement of frailty is not part of standard care and is only emerging as a concept for primary care [12, 13]
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