Implementing Falls Prevention in Primary Care: Barriers and Facilitators

Abstract

Purpose

Limited information is available concerning primary care providers’ encountered barriers and facilitators when implementing falls prevention and providing interventions in a real-life setting. This study aimed to identify barriers and facilitators when i) implementing a falls risk assessment strategy at GP practices and among community nurses and ii) providing evidence-based falls prevention interventions in a real-life setting to independently living, frail older people.

Methods

A researcher’s journal was maintained during the implementation of a falls risk assessment strategy, which entailed notes from informal conversations with GPs, practice nurses and community nurses. After implementation, two online focus groups with GPs, practice and community nurses, physio- and exercise therapists were conducted. Data were thematically analyzed.

Results

Data were collected from 32 GPs, 13 practice nurses, eight community nurses, nine physiotherapists, and two exercise therapists. The GPs and nurses acknowledged that falls prevention is part of their job, meaningful, and that they have sufficient knowledge and skills to offer falls prevention. Collaboration, a previously implemented care program for older people, resources, reimbursement for interventions, and patients’ motivation, awareness and health issues were considered to be important factors for the implementation of falls prevention. Physio- and exercise therapists described collaboration with different disciplines, receiving sufficient referrals, reimbursements, intensity and set-up of the interventions, and patients’ motivation, expectations, goals, self-confidence, awareness, and health issues as important factors when providing falls prevention interventions.

Conclusion

This study identified care provider-, context-, patient-, and innovation (strategy)-related barriers and facilitators when implementing falls prevention and providing interventions in primary care. Development of a more successful implementation strategy should focus on intensifying collaboration, reimbursement for interventions, availability of resources, and patients’ lack of motivation and health issues. Hence, falls prevention may become more structurally applied, reducing a major threat for the quality of life of independently living older people.

Keywords:

• falls prevention
• implementation
• barriers and facilitators
• frail older people
• primary care

Acknowledgment

We would like to thank Zorggroep PrimaCura; Thebe Wijkverpleging; and all participating GPs, practice nurses, district nurses, physio- and exercise therapists, and patients for their support and participation in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interests in this work.

Additional information

Funding

This work is supported by ZonMw, the Netherlands Organization for Health Research and Development, grant number [531001210] (see https://www.zonmw.nl/nl/over-zonmw/ehealth-en-ict-in-de-zorg/programmas/project-detail/preventie-5-deelprogramma-4-preventie-in-de-zorg/valpreventie-in-de-zorg-geimplementeerd). The funder had no role in the creation of the research question, design of the study, data collection, analysis, interpretation, or the writing of this manuscript.