Managing Frailty in an Irish Primary Care Setting: A Qualitative Study

Introduction: Frailty is a complex age-related condition which challenges healthcare systems due to its inherent risk of adverse outcomes and population ageing. Primary Care Teams and GPs are at the frontline of managing frailty in Primary Care. Managing frailty in Primary Care is a priority yet, little is known about the view of key healthcare professionals and patients on the concept of frailty and how it is managed within Primary Care in the Irishcontext. Aims: The aim of this study was to explore the views of Primary Care healthcare professionals and frail older people regarding frailty and the feasibility of introducing frailty screening and Comprehensive Geriatric Assessment (CGA) to Primary Care. Objectives: To explore healthcare professionals’ and patients’ understanding of the concept of frailty; to explore service delivery in Primary Care; to determine facilitators and barriers to implementing frailty screening and CGA to Primary Care; and to explore service-users experiences of care provision in Primary Care. Methods: A qualitative descriptive study was conducted, based on 20 semi-structured interviews, within one Primary Care area in Ireland using combined purposive and snowball sampling. Seventeen participants were healthcare professionals from five specialities, namely GP, public health nursing, physiotherapy, occupational therapy and social work. A small sample of three patients also participated. Data were audio-recorded, transcribed and analysed using Braun and Clarke thematic analysis methodology. An external validator was used for code and theme validation. This research was approved by the local HSE ethicscommittee. Results: Three main themes emerged: (i) Perceptions of Frailty, (ii) Current Management of Frailty and (iii) CGA in Primary Care. This study suggests a lack of knowledge on the broader concept of frailty among participants. Frailty management is challenging due to a lack of resources, inadequate IT systems and inadequate integration. Screening and CGA was considered feasible in Primary Care with an adequately resourced and skilled workforce. However, an intermediate interface service may provide optimal care to frail older people. Conclusions and Implications of findings: This study identified training needs to facilitate a shared understanding of the concept of frailty to positively influence its effective management. Support for screening and CGA was also evident with mixed views on how this should be implemented. The suggestion of a frailty interface service by the study participants warrants further research.