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

Abstract

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.