Integrated solutions for sustainable fall prevention in primary care: a pragmatic hybrid-type 2 mixed methods...

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Falls are a significant public health concern among older adults, leading to injury and reduced quality of life.
• Effective fall prevention requires integrated strategies involving general medical practitioners (GPs) and allied health professionals (AHPs).
• Current primary care models may not fully support proactive fall risk assessment and management.

Purpose of the Study:

• To implement and evaluate integrated fall prevention processes and pathways within primary care.
• To assess the impact of educational interventions and a decision-making tool on GPs' fall prevention activities.
• To evaluate the upskilling of AHPs in delivering evidence-based fall prevention interventions.

Main Methods:

• A mixed-methods (parallel) design incorporating surveys, qualitative data, and a cluster randomized controlled trial (RCT).
• Intervention involved workshops for AHPs and educational tools/interventions for GPs in a Primary Health Network (PHN) in Sydney, Australia.
• Data collected through participant surveys, practice change feedback, and patient fall rate analysis.

Main Results:

• AHP workshops increased confidence and enhanced fall prevention delivery (p < 0.001).
• GPs in the intervention group showed increased engagement in fall prevention activities and referrals to AHPs at 3 months (p = 0.002).
• No significant reduction in patient fall rates was observed (IRR = 0.96), though area-wide GP referrals to AHPs increased over 5 years (70% to 82%, p = 0.028).

Conclusions:

• The iSOLVE project successfully equipped GPs with tools and strategies for a more proactive approach to fall prevention.
• Upskilling AHPs and fostering connectivity within primary care networks are crucial for maximizing the impact of fall prevention initiatives.
• While direct fall rate reduction was not achieved, the project improved system-level engagement and referral pathways for fall prevention in older adults.