Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice. A mixed methods study

Abstract

Background: Implementation of frailty identification methods in general practice has hardly been established. To achieve successful implementation, general practitioners (GPs) should be provided with an identification method that suits their needs. EASYcare-TOS is a new frailty identification method that uses a stepped approach and is specifically developed for use in general practice. The first step consists of the GP's frailty judgment based on his prior information on the patient. If the judgment is ‘uncertain’ or ‘frail,’ additional data are collected by a primary care nurse (PCN). The frailty decision is based on clinical reasoning by the GP, without applying predefined cut-offs in a numerical score.

Objective: To evaluate the acceptability of EASYcare-TOS in daily general practice.

Methods A mixed-methods study was conducted. Questionnaires were sent to all professionals (n = 25) who participated in the EASYcare-TOS validation study. Subsequently, semi-structured interviews with primary care professionals (n = 12) and patients (n = 9) were conducted.

Results: Time investment was generally perceived as acceptable. Twenty-two professionals (88%) found a two-step model (very) useful in the identification instrument. Seventeen professionals (68%) valued making the final frailty decision by their own clinical reasoning. Patients appreciated the broad assessment and the advice given based on the assessment. According to 24 (96%) professionals, EASYcare-TOS improved the quality of patient care. GPs stated that implementation will ask for reconsidering allocation of tasks in general practices and adequate reimbursement.

Conclusion: EASYcare-TOS is a new identification method that fits the needs of primary care professionals to a large extent and is acceptable in daily practice.

Keywords::

• frailty
• older patients
• identification
• general practice

FUNDING

This project was funded by grant 60-61900-98-217 of the Dutch National Care for the Elderly Program, coordinated and sponsored by ZonMw, The Netherlands, organization for health research and development.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.