Adoption of the Reference Framework for Preventive Care for Older Adults: a study of primary care physicians

The Reference Framework (RF) for Preventive Care for Older Adults in Primary Care provides evidence-based guidelines to enhance preventive care in Hong Kong. However, its adoption and feasibility among primary care physicians (PCPs) remain unclear. This study evaluates PCPs' awareness, adoption, and perceived barriers and enablers to RF implementation.

A cross-sectional survey conducted among PCPs in Hong Kong. Sociodemographics, adoption of RF and perceptions of implementation barriers and enablers were collected. Logistic regression was used to identify key factors influencing RF applicability, acceptability and feasibility.

Both private and public primary care institutions in Hong Kong.

A total of 485 PCPs who provide preventive care to older adults in primary care settings across both the private and public sectors in Hong Kong participated.

Among 485 physicians surveyed, most considered the RF applicable (71.3%), acceptable (78.1%) and feasible (65.6%), with significantly higher acceptability and feasibility reported by private physicians. Adoption of RF recommendations varied widely (17.5%-92.8%), with highest uptake for influenza vaccination and lowest for urinary incontinence screening. Private physicians more often viewed frequent RF updates as facilitators and market competition as a barrier, while public physicians more frequently reported incompatibility with clinical settings. Physicians seeing 30-59 patients per day were more likely to find the RF applicable (adjusted OR 2.123, 95% CI 1.201 to 3.753, p=0.010) compared with those who provided consultation for fewer than 30 patients per day.

While most PCPs perceived the RF as applicable, acceptable and feasible, significant variation in adoption across recommendations and between practice settings highlights implementation challenges. Key enablers included high-quality evidence and local clinical information, while barriers like time constraints and patient adherence highlight the need for regular updates, ongoing education and tailored strategies for wider RF adoption.