Clemson, L., Mackenzie, L., Lovarini, M. et al. (10 more authors) (2024) Integrated solutions for sustainable fall prevention in primary care: a pragmatic hybrid-type 2 mixed methods implementation and effectiveness study. Frontiers in Public Health, 12. 1446525. ISSN 2296-2565
Abstract
The iSOLVE implementation project established and evaluated integrated processes and pathways, including a decision-making tool and educational interventions for general medical practitioners (GPs) and the upskilling of allied health professionals (AHPs). The study used a mixed-methods (parallel) design comprising surveys, qualitative methodologies, and an embedded cluster randomized controlled trial (RCT). Sampling was conducted within a Primary Health Network (PHN) geographic area in Sydney, Australia. AHP workshops (n = 367 attendees) covered six evidence-based interventions, resulting in increased confidence (p < 0.001) and numerous enhancements in fall prevention delivery. Among GPs, 75 were recruited from 27 practices. GPs in the experimental group were more likely to engage in fall prevention activities, including risk assessments, medication reviews, and providing advice, compared to the control group (p = 0.002). They were also more likely to refer patients to AHPs at 3 months (p = 0.002); however, this effect was not significant at 12 months (p = 0.13), as referral behaviors increased in the control group over time. Responses to free-text questions of practice change highlighted differences, with the experimental group reporting a more proactive and comprehensive approach to fall prevention. In a subset of GP patients (n = 560), no significant effect was observed in reducing the rate of falls (IRR = 0.96). The pragmatic nature of the project and potential contamination across multiple elements likely influenced this outcome. However, an area-wide survey of GPs (n = 562) revealed an increase in fall prevention referrals to AHPs over 5 years, from 70 to 82% (p = 0.028). Our findings highlight the importance of equipping GPs with tools and strategies to adopt a proactive approach to fall prevention among older patients. AHPs play a crucial role in this effort, and fostering relationships and connectivity across primary care networks is essential to maximizing the impact of fall prevention initiatives.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | allied health; cluster randomized controlled trial; fall prevention; family practice physicians; general medical practice; mixed-methods; parallel study design; surveys; Humans; Accidental Falls; Primary Health Care; Australia; Female; Male; Surveys and Questionnaires; General Practitioners; Middle Aged; Allied Health Personnel; Aged |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Funding Information: | Funder Grant number National Health and Medical Research Council 1072790 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 31 Jan 2025 11:32 |
Last Modified: | 31 Jan 2025 11:32 |
Published Version: | https://doi.org/10.3389/fpubh.2024.1446525 |
Status: | Published |
Publisher: | Frontiers Media SA |
Refereed: | Yes |
Identification Number: | 10.3389/fpubh.2024.1446525 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:222573 |