Adaptation of DETECT for Use in Home-Based Primary Care: Clinician Perspectives

Elder mistreatment (EM) is pervasive yet under-identified. The Detection of Elder abuse Through Emergency Care Technicians (DETECT) tool was developed to improve EM identification and reporting among emergency medical technicians. This study explores clinician perspectives on adapting DETECT for use in home-based primary care (HBPC).

A qualitative study was conducted using semi-structured interviews and focus groups with HBPC clinicians (N = 16) across seven intervention sites. Discussions focused on barriers and facilitators to EM identification and response, engagement with Adult Protective Services (APS), and recommendations for adapting DETECT. Thematic analysis was performed.

Three themes emerged: (1) EM as an overlooked priority-clinicians recognized EM as critical but lacked standardized screening tools and protocols; (2) Barriers and facilitators to screening and response-time constraints, complexity of EM cases, and APS hesitancy were barriers, while continuity of care and team-based approaches were facilitators; (3) Recommended DETECT adaptations-clinicians suggested modifications to item phrasing, an emphasis on tracking observations over time, and a scoring system incorporating safety risk levels.

HBPC clinicians support a standardized EM screening tool and emphasize the need for flexibility in reporting and response. Findings will inform modifications to DETECT that align with HBPC workflows and improve EM identification while maintaining patient-clinician relationships.