Impact of identifying and providing management support for people at risk of frailty in general practice.

Introduction: Frailty, associated with increasing age and characterised by diminished strength and function, often remains undetected. Presentations of frailty frequently occur when a seemingly minor event results in a significant health crisis and unnecessary hospital admission, with substantial associated health care costs. Evidence suggests that targeted therapies may decrease the negative outcomes associated with being frail. In Australia frailty affects up to 25% of people aged ≥70 yet a standardised assessment of frailty amongst patients attending general practice is not routine. The FRAIL Scale, developed and validated internationally as a screening tool, requires five simple questions to be answered to identify risk of frailty. (Morley et al, 2012) A FRAIL Scale Tool has been developed which can be built into the General Practice clinical support system. The study is investigating the 1) feasibility and adoption of the Tool by general practices; 2) access to resources and referral options in the community to support identified need; 3) acceptability to providers, patients, and carers of the risk of frailty assessment and management approach. Who is it for: The FRAIL Scale Tool is used by general practice staff who complete older person health assessments in the practice. Who is involved/engaged: General practice staff, Queensland Primary Health Networks, Royal Australian College of General Practitioners, Mater Research Institute-The University of Queensland. What did we do: A retrospective chart audit of patients who had 75 and over health assessments in the 12 months prior to implementing the FRAIL Scale Tool was conducted, to determine whether any of the five frailty indices (fatigue, resistance, ambulation, illness, weight loss) had been assessed. Using the Tool practices screened eligible patients (≥75 yrs) for frailty and referred to the associated management options. The percent of patients identified as frail and pre-frail, and the management options and referrals made by GPs for those identified as pre-frail and frail were recorded. Semi-structured qualitative interviews were conducted with practice staff who used the Tool. Interview transcripts were coded and a deductive thematic analysis was conducted to understand the acceptability and feasibility of the tool. Results/ impact: Our audit of 348 patients aged ≥75 years who had completed annual health assessments in 12 Australian general practices, found only 2% had been assessed for all five Frail Scale components. The Tool was implemented by 19 general practices and 1071 patients were assessed. Both pre-frail (49%) and frail (32%) patients were predominantly referred for exercise prescription, geriatric assessment, and medication reviews. The tool was acceptable to staff and patients and compatible with practice workflows. Learning for international audience: Frailty identification, linked with management support to reverse or reduce frailty risk, can be readily incorporated into an annual health assessment. Next steps: To identify the barriers to accessing services and resources required to support those at risk of frailty. A reduced burden to the hospital system, improved health outcomes and quality of life for older people are potential benefits of an effective tool used routinely in general practice to assess frailty risk, a focus of future research.