Br J Gen Pract. 2021 Mar 2:BJGP.2020.0178. doi: 10.3399/BJGP.2020.0178. Online ahead of print.
ABSTRACT
BACKGROUND: In England, general practitioners (GPs) are independent contractors working to a national contract. Since 2017 the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged 65 and over and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement.
AIM: To explore GPs’ views of identifying frailty and offering interventions for those living with moderate or severe frailty.
DESIGN AND SETTING: Sequential mixed-methods study of GPs in the East Midlands region of England (Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, Northamptonshire) between January and May 2019.
METHODS: Survey of GPs by online questionnaire, followed by semi-structured interview. Based on survey responses GPs with a range of views on identifying frailty, GP and practice characteristics, were selected for interview. Questionnaires were analysed using descriptive statistics. Interview transcripts were analysed using framework analysis.
RESULTS: 188 (6.1%) GPs responded to the survey and 18 GPs were interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification tools lacked sensitivity and specificity and wanted evidence showing clinical benefit. Frailty identification increased workload and was under-resourced, with limited time for, and access to necessary interventions. GPs felt they lacked knowledge about frailty and more education was required.
CONCLUSION: Proactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, access to interventions to lessen the impact of frailty and adequate resourcing to achieve its potential clinical impact.
PMID:33657008 | DOI:10.3399/BJGP.2020.0178
