Integrating Falls Specialist Referrals into Primary Care: Barriers and Implementation

Falls are common among the older adult (≥ 65 years) population and may result in significant morbidity and mortality, including: diminished physical and cognitive ability, exacerbation of chronic medical conditions, isolation, hospitalizations, and death. Because of serious implications for the individual, caregiver, and community, primary care providers (PCPs) are responsible for identifying older adults at risk for falls. Unfortunately, many PCPs fail to routinely implement fall risk screenings, thus putting their patients at increased risk for falls. Utilizing a systematic fall risk screening for all patients 65 years and older in a primary care setting, followed by referral to a fall specialist, may prevent falls and improve quality of life for older adult patients. Falls among older adults are predictable events, and at least one-third of all falls can be prevented through proper screening implementation. The literature demonstrates a wide variety of suggestions in regards to fall risk screening methods (functional assessments, questionnaires, or risk-prediction tools), but national guidelines continue to suggest that PCPs perform a fall risk screening at least annually for all older adult patients, followed by a comprehensive fall risk assessment for those who screen positive. A comprehensive falls risk assessment has several lengthy components. Thus, time constraints, in addition to knowledge deficits, and examiner bias are reported by PCPs as significant barriers to performing consistent fall risk screenings. The literature demonstrates a trend toward utilizing short, self-report-based fall risk screenings more frequently, followed by referral to a fall specialist, if the screen is positive. The objectives of this project were: (1) to identify the barriers of consistent utilization of fall risk screenings and increase the likelihood of consistent utilization of fall risk screenings of older adults in a primary care setting; (2) to increase older adult referrals to fall specialists for comprehensive falls risk screening in a faint and fall, physical therapy, geriatrician, or other fall specialty clinic and (3) to disseminate findings to a wider audience for trial implementation. Implementation and evaluation steps were: (1) administering a pre-project implementation survey to a primary care clinic staff to assess for barriers to fall risk screening implementation; (2) delivering a training course for clinic staff and providers on the fall risk screening and fall specialist referral process; (3) initiating a new falls risk screening process; (4) administering a post-project implementation survey to the primary care clinic staff to assess for continued barriers to implementation; (5) comparing pre- and post-implementation survey data, as well as Epic® data, to evaluate if barriers to performing fall risk screenings decreased, and if the number of fall risk screenings and referrals to fall specialists increased. In summary, identifying older adults at risk for falls is vital to older adult health and quality of life. PCPs perceive significant barriers to comprehensive fall risk screening implementation, including lack of time and expertise. Fortunately, literature supports PCPs utilizing short, questionnaire-based fall risk screening tools more frequently than annually, and referring patients at risk for falls to fall specialists