Perceptions of physicians on the barriers and facilitators to integrating fall risk evaluation and management into practice.
BACKGROUND
Falls are common, treatable, and result in considerable morbidity in older adults. However, fall risk factor evaluation and management targeted at high-risk patients is largely neglected in clinical practice.


OBJECTIVE
To identify barriers and facilitators to the implementation of fall risk management by primary care providers.


METHODS
Qualitative study using a semi-structured interview.


METHODS
Primary care providers who received an academic outreach visit.


METHODS
Self-reported facilitators and barriers to evaluating and managing fall risk in older patients.


RESULTS
Physician factors, logistical factors, and patient factors intersect to either facilitate or impede fall risk evaluation and management by primary care providers. Physician factors include awareness, competing risks, appropriateness of referrals, training, and tie-in to familiar activities. Logistical factors include availability of transportation, time requirements of immobile patients, reimbursement, scheduling, family involvement, and utilization of other health care providers. Physicians' perceptions of patient factors include reporting, attitudes toward medication, and positive feedback.


CONCLUSIONS
Strategies to improve the adoption of fall risk evaluation and management in primary care should address the specific physician, logistical, and patient barriers perceived by physicians who had received an informative, motivational intervention to assess and manage falls among their patients.
Chou
William C
WC
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. william.chou@aya.yale.edu
Tinetti
Mary E
ME
King
Mary B
MB
Irwin
Kevin
K
Fortinsky
Richard H
RH
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D006801:Humans; D007407:Interviews as Topic; D009934:Organization and Administration; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods*; D011364:Professional Practice; D018570:Risk Assessment; D012308:Risk Management