title: Comparison of different strategies of referral to a fall clinic: how to achieve an optimal casemix?
abstract: OBJECTIVE To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Fall clinics in two university teaching hospitals in the Netherlands.
  
  
  METHODS
  Three hundred community-dwelling older people aged 65 years or over currently attending the fall clinics in Nijmegen (Group 1, n=154) and in Amsterdam (Group 2, n=146).
  
  
  METHODS
  Patients were referred by a general practitioner (Group 1) or were selected using the Carefall Triage Instrument (CTI) after visiting the emergency department (Group 2). In all patients, modifiable risk factors for recurrent falls were assessed.
  
  
  RESULTS
  Group 1 had less modifiable risk factors for falling (a mean of 4 (SD 1.6) vs. a mean of 5 (SD 1.5) in Group 2, p < 0.001). Compared to Group 2, Group 1 had more prevalent " recurrent falling (≥ 2 falls)" (p=0.001) and "assisted living in homes for the aged" (p=0.037). "Fear of falling", "mobility and balance problems", "home hazards" and "osteoporosis" were significantly less prevalent in Group 1.
  
  
  CONCLUSIONS
  This study suggests that patients referred to a multidisciplinary fall prevention clinic by their general practitioner have a different risk profile than those selected by case finding using the CTI. These differences have consequences for the reach of secondary care for fall-preventive interventions and will probably influence the effectiveness and efficiency of a fall prevention program.
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Schoon
authors.forename: M E
authors.initials: ME
authors.lastname: Hoogsteen-Ossewaarde
authors.forename: A C
authors.initials: AC
authors.lastname: Scheffer
authors.forename: F J M
authors.initials: FJ
authors.lastname: Van Rooij
authors.forename: M G M Olde
authors.initials: MG
authors.lastname: Rikkert
authors.forename: S E
authors.initials: SE
authors.lastname: De Rooij
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D009426:Netherlands; D015995:Prevalence; D012008:Recurrence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors