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Published (Version of record)CC BY V4.0, Open Access
Published (Version of record)CC BY V4.0, Open
Journal article
Integrated solutions for sustainable fall prevention in primary care: a pragmatic hybrid-type 2 mixed methods implementation and effectiveness study
Frontiers in public health, Vol.12, pp.1-20
12/2024
PMID: 39703488
Appears in Recent Faculty of Health Publications
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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.
Details
- Title
- Integrated solutions for sustainable fall prevention in primary care: a pragmatic hybrid-type 2 mixed methods implementation and effectiveness study
- Creators
- Lindy Clemson - The University of SydneyLynette Mackenzie - The University of SydneyMeryl Lovarini - The University of SydneyChristopher Roberts - The University of SydneyRoslyn Poulos - UNSW SydneyCatherine Sherrington - The University of SydneyAmy C.W. Tan - The University of SydneyJudy Simpson - The University of SydneyConstance Dimity Pond - University of Newcastle AustraliaSabrina Pit - The University of SydneyAnne Tiedemann - The University of SydneyLorraine Lovitt - Clinical Excellence Commission NSW (Australia)Sarah N. Hilmer - Northern Sydney Local Health District
- Publication Details
- Frontiers in public health, Vol.12, pp.1-20
- Publisher
- Frontiers Media S.A.
- Grant note
- The project was supported by a National Health and Medical Research Council (NHMRC) Partnership grant 1072790.
- Identifiers
- 991013344083402368
- Copyright
- © 2024 Clemson, Mackenzie, Lovarini, Roberts, Poulos, Sherrington, Tan, Simpson, Pond, Pit, Tiedemann, Lovitt and Hilmer.
- Academic Unit
- Faculty of Health
- Language
- English
- Resource Type
- Journal article