Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice

Document Type: Original Article

Authors

1 Department of Family Medicine, Dalhousie University, Halifax, NS, Canada

2 Research and Innovation, Nova Scotia Health Authority, Primary Health Care & Chronic Disease Management, Halifax, NS, Canada

3 Dalhousie University, Halifax, NS, Canada

4 School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada

5 Health Populations Institute, Dalhousie University, Halifax, NS, Canada

6 Continuing Care, Nova Scotia Health Authority, Halifax, NS, Canada

7 Nova Scotia Health Authority, Halifax, NS, Canada

8 Division of Geriatric Medicine, Nova Scotia Health Authority, Halifax, NS, Canada

9 Palliative and Therapeutic Harmonization (PATH) Program, Halifax, NS, Canada

10 Department of Family Practice, Nova Scotia Health Authority, Halifax, NS, Canada

11 Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada

12 Primary Heath Care, Family Practice and Chronic Disease and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada

13 Chronic Disease and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada

Abstract

Background
Understanding and addressing the needs of frail patients has been identified as an important strategy by the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension which garner a disease-based approach and identification as part of standard practice, frailty is only just emerging as a concept for PC. The web-based Frailty Portal was developed to aid in the identification of, assessment and care planning for frail patients in PC practice. In this study we assess the implementation feasibility and impact of the Frailty Portal by: (1) identifying factors influencing the Frailty Portal’s use in community PC practice, and (2) examination of the immediate impact of the ‘Frailty Portal’ on frail patients, their caregivers and PC providers.
 
Methods
A convergent mixed method approach was implemented among PC providers in community-based practice in the NSHA, Central Zone. Quantitative and qualitative data were collected concurrently over a 9-month period. A sample of patients who underwent assessment and/or their caregiver were approached for survey participation.
 
Results
Fourteen community PC providers (10 family physicians, 4 nurse practitioners) completed 48 patient assessments and completed or begun 41 care plans; semi-structured interviews were conducted among 9 providers. Nine patients and 5 caregivers participated in the survey. PC providers viewed frailty as an important concept but implementation challenges were met, primarily with respect to the time required for use and lack of fit with traditional practice routines. Additional barriers included tool usability and accessibility, training and care planning steps, and privacy. Impacts of the tools use with respect to confidence and knowledge showed early promise.
 
Conclusion
This feasibility study highlights the need for added health system supports, resources and financial incentives for successful implementation of the Frailty Portal in community PC practice. We suggest future implementation integrate the Frailty Portal to practice electronic medical records (EMRs) and target providers with largely geriatric practice populations and those practicing within interdisciplinary, collaborative primary healthcare (PHC) teams.

Keywords

Main Subjects


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