Kielich Kajtek, Mackenzie Lynette, Lovarini Meryl, Clemson Lindy
Ageing Work and Health Research Unit, Faculty of Health Sciences, 75 East Street, University of Sydney, Lidcombe, NSW 2141, Australia. Email: ;
Aust Health Rev. 2017 Mar;41(1):111-119. doi: 10.1071/AH15152.
Objective The study aimed to explore Australian general practitioners' (GPs) perceptions of falls risk screening, assessment and their referral practices with older people living in the community, and to identify any barriers or facilitators to implementing evidence-based falls prevention practice. Methods Hardcopy surveys and a link to an online survey were distributed to 508 GPs working at one Medicare Local (now part of a Primary Care Network) located in Sydney, Australia. Data were analysed using descriptive statistics and key themes were identified from open text responses. Results A total of 37 GPs returned the survey. Only 10 (27%) GPs routinely asked older people about falls, and five (13.5%) asked about fear of falls during clinical consultations. Barriers to managing falls risk were identified. GPs estimated that they made few referrals to allied health professionals for falls interventions. Conclusions GPs were knowledgeable about falls risk factors but this did not result in consistent falls risk screening, assessment or referral practices. Due to the small sample, further research is needed with a larger sample to augment these results. What is known about the topic? Falls are a common and serious health issue for older people and fall prevention is vital, especially in the primary care setting. General practitioners (GPs) are key health professionals to identify older people at risk of falls and refer them to appropriate health professionals for intervention. Evidence-based falls prevention interventions exist but are not easily or routinely accessed by older people. What does this paper add? GPs believe that previous falls are an important falls risk factor but they do not routinely ask about falls or fear of falls in clinical practice with older people. GP referral rates to allied health professionals for falls prevention are low, despite evidence-based falls prevention interventions being provided by allied health professionals. There are several barriers to GPs providing falls prevention assessment and intervention referrals, particularly using the current primary health systems. What are the implications for practitioners? GPs need to recognise their potential significant contribution to falls prevention in the community and may require tailored training. Sustainable evidence-based referral pathways need to be developed so that older people can be referred to allied health professionals for falls prevention interventions in the primary care setting, and better local networks need to be developed to allow this to occur. Policy makers may have to address the identified barriers to multidisciplinary practice and funding of services to facilitate effective falls prevention programs in primary care.
目的 本研究旨在探讨澳大利亚全科医生（GPs）对社区老年人群跌倒风险筛查、评估及其转诊实践的看法，并确定实施循证跌倒预防实践的任何障碍或促进因素。方法 向在澳大利亚悉尼一个医疗保险区域（现为初级保健网络的一部分）工作的508名全科医生发放了纸质调查问卷以及在线调查问卷链接。使用描述性统计方法分析数据，并从开放式文本回答中确定关键主题。结果 共有37名全科医生回复了调查问卷。只有10名（27%）全科医生在临床会诊时常规询问老年人是否跌倒，5名（13.5%）询问是否有跌倒恐惧。确定了管理跌倒风险的障碍。全科医生估计他们很少将会诊患者转诊给专职医疗人员进行跌倒干预。结论 全科医生了解跌倒风险因素，但这并未导致一致的跌倒风险筛查、评估或转诊实践。由于样本量小，需要用更大样本进行进一步研究以补充这些结果。关于该主题已知的情况是什么？跌倒是老年人常见且严重的健康问题，预防跌倒至关重要，尤其是在初级保健环境中。全科医生是识别有跌倒风险的老年人并将他们转诊给适当的健康专业人员进行干预的关键健康专业人员。存在循证跌倒预防干预措施，但老年人不容易或不常规能获得这些措施。本文补充了什么？全科医生认为既往跌倒为重要的跌倒风险因素，但他们在对老年人的临床实践中并不常规询问是否跌倒或是否有跌倒恐惧。尽管专职医疗人员提供了循证跌倒预防干预措施，但全科医生向专职医疗人员进行跌倒预防的转诊率较低。全科医生提供跌倒预防评估和干预转诊存在若干障碍，特别是在使用当前的初级卫生系统时。对从业者有何启示？全科医生需要认识到他们在社区跌倒预防中可能做出的重大贡献，可能需要针对性培训。需要制定可持续的循证转诊途径，以便在初级保健环境中能将老年人转诊给专职医疗人员进行跌倒预防干预，并且需要建立更好的地方网络以实现这一点。政策制定者可能必须解决已确定的多学科实践障碍和服务资金问题，以促进初级保健中有效的跌倒预防计划。
