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Multidisciplinary care pathways for falls prevention in older adults: visualizing the needs of primary care-based
Sara S Groos1,2, Stefanie M Tan3, Annemiek J Linn4
1Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands. s.s.groos@amsterdamumc.nl.
Purpose:
Multidisciplinary care pathways for falls prevention, which include falls risk stratification, multifactorial falls risk assessment, and management of multidomain interventions, can reduce falls in older adults. However, efficient multidisciplinary falls prevention care is challenging due to issues such as poor communication and role allocation. This study aimed to identify and visualize the multidisciplinary care needs of primary care-based health care professionals (HCPs) for falls prevention in the Netherlands using the novel co-design approach of journey mapping.
Methods:
Online focus groups and interviews (N = 45) were conducted with physical therapists (n = 15), district nurses (n = 9), occupational therapists (n = 7), pharmacists (n = 6), nurse practitioners (n = 5), podiatrists (n = 2), and one general practitioner. HCPs were asked about their interactions, experiences, needs, and barriers with regards to multidisciplinary falls prevention care in a primary care context. Insights were used to visualize a journey map depicting the desired future state of multidisciplinary care pathways for falls prevention.
Results:
Journey mapping identified the following needs for effective multidisciplinary falls prevention care: a dedicated case manager after risk stratification, preparatory patient information before the assessment, small multidisciplinary care team for the assessment, patient involvement during intervention management, good communication between HCPs, and a reduction in workload for HCPs.
Conclusion:
The inclusion of a case manager program for older adults and access to resources to facilitate good communication between HCPs are important to optimize the configuration of multidisciplinary care pathways for falls prevention in actual practice.
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