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      Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocol

      systematic-review
      , ,
      BMJ Open
      BMJ Publishing Group
      geriatric medicine, health policy, protocols & guidelines

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          Abstract

          Introduction

          Frailty is an increasingly common condition in which physiological decline as a result of accumulated deficits renders older people more vulnerable to adverse outcomes. An increasing range of frailty screening programmes have been introduced in primary care to identify frail older people in order to deliver appropriate interventions. However, limited information on the knowledge and attitude of healthcare professionals (HCPs) with respect to frailty screening is known. The aim of this systematic review is to provide evidence on the knowledge and attitude of HCP in terms of frailty screening, and potentially identify barriers and facilitators to frailty screening to improve implementation of frailty screening in primary care.

          Methods/design

          A systematic review of qualitative research will be conducted. Databases searched will be MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Web of Science from January 2001 to August 2019. Methods will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Population, interest, context and study design methodology was used to develop inclusion and exclusion criteria with HCPs as population, frailty screening as interest and knowledge or attitude of HCPs to frailty screening as context. Studies with a qualitative methodology or a mixed-method design where the qualitative component is analysed separately will also be included. Quality appraisal will be carried out using the Joanna Briggs Institute appraisal tool for qualitative studies. Data will be extracted from each selected study with thematic framework analysis used to synthesise findings.

          Ethics and dissemination

          This systematic review does not require ethical approval as primary data will not be collected. The findings will be disseminated at conferences and in a relevant academic journal. This review will assist HCPs and relevant stakeholders to tackle the challenges of frailty screening in primary care.

          PROSPERO registration number

          CRD42019159007.

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          Most cited references14

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          Frailty: an emerging research and clinical paradigm--issues and controversies.

          Clinicians and researchers have shown increasing interest in frailty. Yet, there is still considerable uncertainty regarding the concept and its definition. In this article, we present perspectives on key issues and controversies discussed by scientists from 13 different countries, representing a diverse range of disciplines, at the 2006 Second International Working Meeting on Frailty and Aging. The following fundamental questions are discussed: What is the distinction, if any, between frailty and aging? What is its relationship with chronic disease? Is frailty a syndrome or a series of age-related impairments that predict adverse outcomes? What are the critical domains in its operational definition? Is frailty a useful concept? The implications of different models and approaches are examined. Although consensus has yet to be attained, work accomplished to date has opened exciting new horizons. The article concludes with suggested directions for future research.
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            Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data.

            A general frailty indicator could guide general practitioners (GPs) in directing their care efforts to the patients at highest risk. We investigated if a Frailty Index (FI) based on the routine health care data of GPs can predict the risk of adverse health outcomes in community-dwelling older people. This was a retrospective cohort study with a 2-year follow-up period among all patients in an urban primary care center aged 60 and older: 1,679 patients (987 women [59%], median age, 73 years [interquartile range, 65-81]). For each patient, a baseline FI score was computed as the number of health deficits present divided by the total number of 36 deficits on the FI. Adverse health outcomes were defined as the first registered event of an emergency department (ED) or after-hours GP visit, nursing home admission, or death. In total, 508 outcome events occurred within the sample population. Kaplan-Meier survival curves were constructed according to FI tertiles. The tertiles were able to discriminate between patients with low, intermediate, and high risk for adverse health outcomes (p value < .001). With adjustments for age, consultation gap, and sex, a one deficit increase in the FI score was associated with an increased hazard for adverse health outcomes (hazard ratio, 1.166; 95% confidence interval [CI], 1.129-1.210) and a moderate predictive ability for adverse health outcomes (c-statistic, 0.702; 95% CI, 0.680-0.724). An FI based on International Classification of Primary Care (ICPC)-encoded routine health care data does predict the risk of adverse health outcomes in elderly population.
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              The challenge of ageing populations and patient frailty: can primary care adapt?

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                2 July 2020
                : 10
                : 7
                : e037523
                Affiliations
                [1]departmentInstitute for Health Research , University of Bedfordshire , Luton, Bedfordshire, UK
                Author notes
                [Correspondence to ] Dr Gurch Randhawa; gurch.randhawa@ 123456beds.ac.uk
                Author information
                http://orcid.org/0000-0002-0850-1112
                http://orcid.org/0000-0002-2289-5859
                http://orcid.org/0000-0002-7656-4000
                Article
                bmjopen-2020-037523
                10.1136/bmjopen-2020-037523
                7333811
                32616492
                048d6436-f5be-4145-bcc8-8153d14087a5
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 05 February 2020
                : 23 April 2020
                : 29 May 2020
                Categories
                Geriatric Medicine
                1506
                1698
                Protocol
                Custom metadata
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                Medicine
                geriatric medicine,health policy,protocols & guidelines
                Medicine
                geriatric medicine, health policy, protocols & guidelines

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