1Building Research for Integrated Primary Healthcare (BRIC NS), Nova Scotia Primary & Integrated Health Care Innovations Network, Halifax, NS, Canada
2Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS, Canada
3Dalhousie University, Halifax, NS, Canada
4Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
5School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
6Continuing Care, Nova Scotia Health Authority, Halifax, NS, Canada
7Healthy Populations Institute, Halifax, NS, Canada
8Palliative and Therapeutic Harmonization (PATH) Program, Halifax, NS, Canada
9Department of Family Practice, Nova Scotia Health Authority, Halifax, NS, Canada
Background Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice.
Methods This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative’s feasibility and scalability. Methods will be informed by the ‘Implementing the Frailty Portal in Community Primary Care Practice’ logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR).
Discussion The ‘Frailty Portal’ aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers’ ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports.
Fried LP, Walston J. Frailty and failure to thrive (1487-1502). In: Hazzard WR, Blass JP, Ettinger WH Jr, Halter JB, Ouslander J, eds. Principles of Geriatric Medicine and Gerontology. 5th ed. New York: McGraw-Hill; 2003.
British Geriatrics Society. Fit for Frailty: Consensus best practice guidelines for the care of older people living with frailty in community and outpatient settings. London: British Geriatrics Society; 2014.
Fairhall N, Sherrington C, Clemson L, Cameron ID. Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis. Age Ageing. 2011;40(6):666-674. doi:10.1093/ageing/afr077
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255-263.
Lee L, Heckman G, Molnar FJ. Identifying elderly patients at high risk of poor outcomes. Can Fam Physician. 2015;61(3):227-231.
Buckinx F, Rolland Y, Reginster J-Y, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Health. 2015;73(1):19. doi:10.1186/s13690-015-0068-x
Rougé Bugat ME, Cestac P, Oustric S, Vellas B, Nourhashemi F. Detecting frailty in primary care: A major challenge for primary care physicians. Journal of J Am Med Dir Assoc. 2012;13(8):669-672.doi:10.1016/j.jamda.2012.07.015
Drey M, Wehr H, Wehr G, et al. The frailty syndrome in general practitioner care: a pilot study. Z Gerontol Geriatr. 2011;44(1):48-54. doi:10.1007/s00391-010-0136-3
Lacas A, Rockwood K. Frailty in primary care: A review of its conceptualization and implications for practice. BMC Med. 2012;10:4. doi:10.1186/1741-7015-10-4
Collins Higgins T, Crosson J, Peikes D, McNellis R, Genevro J, Meyers D. Agency for Healthcare Research and Quality. Using health information technology to support quality improvement in primary care (HRQ Publication No. 15-0031-FF). Rockville, MD: US Department of Health and Human Services; 2015.
De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: An emerging concept for general practice. Br J Gen Pract. 2009;59(562):e177-e182.
Keiren SM, van Kempen JA, Schers HJ, Olde Rikkert MG, Perry M, Melis RJ. Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice: A mixed methods study. Eur J Gen Pract. 2012;20(2):107-113. doi:10.3109/13814788.2013.827167
Pialoux T, Goyard J, Lesourd B. Screening tools for frailty in primary health care: A systematic review. Geriatr Gerontol Int. 2012;12(2):189-197. doi:10.1111/j.1447-0594.2011.00797.x
Braithwaite RS, Fiellin D, Justice AC. The payoff time: A flexible framework to help clinicians decide when patients with comorbid disease are not likely to benefit from practice guidelines. Med Care. 2009;47(6):610-617.
Moorhouse P, Mallery LH. Palliative and therapeutic harmonization: A model for appropriate decision‐making in frail older adults. J Am Geriatr Soc. 2012;60(12):2326-2332. doi:10.1111/j.1532-5415.2012.04210.x
Mallery LH, Moorhouse P. Respecting frailty. J Med Ethics. 2011;37(2):126-128.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50
Moorhouse P, Mallory LH. Screening for Frailty: Instructions for Using the FACT. Halifax, NS: Authors; 2015.