Evaluating the implementation of risk of frailty screening and intervention for older Australians in general practice (Preprint)

BACKGROUND Frailty increases with age and is associated with increased vulnerability to adverse health outcomes. International guidelines recommend screening for frailty in primary care, however, this is not routine practice in Australia. Once identified, frailty progression has the potential to be halted or reversed with early intervention. The FRAIL Scale Tool, a simple and validated screening and management tool, offers a feasible approach for integration into the Australian health assessment for those aged 75 years and over (75+HA), which can be performed annually by a general practitioner. OBJECTIVE This study explores the incidence of frailty, required resources to support management, and implementation factors within general practice settings. METHODS A mixed-methods evaluation was conducted in 24 general practices across two Australian Primary Health Network regions, Sydney North and Brisbane South. The FRAIL Scale Tool was implemented during the 75+ health assessment and data collected on FRAIL Scale scores, hospitalisation rates, frailty interventions and barriers to frailty management. Staff perceptions of the long-term sustainment of the FRAIL Scale Tool were assessed with the Provider REport of Sustainment Scale. Semi-structured qualitative interviews conducted with practice staff and patients, explored barriers and enablers to implementing frailty screening and management. Guided by the Consolidated Framework for Implementation Research, transcripts were coded and themes developed. RESULTS Of the 1,484 patients aged ≥75 years who were screened, 15% were frail, 41.5% pre-frail, and 43.5% robust. People who were frail were more likely to be female, older, have more prescribed medications and to have had a non-elective hospitalisation in the three months prior to screening. Management recommendations commonly included medication reviews, aged care packages, assessment for depression, and exercise programs. Barriers identified to accessing interventions included health, transport, cost, and time. Survey and qualitative findings highlighted that the FRAIL Scale Tool was easy to use, and integrate into existing workflows, and sustained use would be supported by software integration. Patients valued the assessment and tailored health support. CONCLUSIONS Screening for frailty is not routinely recorded and tracked in Australian general practice. This study demonstrated feasibility of using the FRAIL Scale Tool during the annual health assessment for people aged 75 and over in general practice. Frail individuals were four times more likely to have had a non-elective hospitalisation in the prior 3 months than those who were pre-frail or robust. Patients and staff value the tool’s simplicity and the opportunity to raise awareness and manage frailty proactively. Incorporating the tool into practice software systems would enhance adoption. Broader implementation and research in diverse settings, including Indigenous populations, are needed to improve frailty prevention and management. CLINICALTRIAL NA