Barriers and Enablers to Early Identification, Referral and Access to Geriatric Rehabilitation Post-Hip Fracture: A Theory-Based Descriptive Qualitative Study

Abstract

Background Geriatric hip fracture patients often experience gaps in care including variability in the timing and the choice of an appropriate setting for rehabilitation following hip fracture surgery. Many guidelines recommend standardized processes, including timely access of no later than day 6 to rehabilitation services. A pathway for early identification, referral and access to geriatric rehabilitation post-hip fracture was created to facilitate the implementation. The study aimed to describe the barriers and enablers prior to the implementation of this pathway. Methods We conducted a qualitative descriptive study consisting of semi-structured interviews with geriatric hip fracture patients (n = 8), caregivers (n = 1), administrators (n = 12) and clinicians (n = 17) in 2 orthopaedics units and a geriatric rehabilitation service. Responses were analysed using a systematic approach, and overarching themes describing the barriers and enablers were identified. Results The clinicians’ and administrators’ top barriers to implementation of the pathway were competing demands (n = 24); lack of bed availability, community resources and funding (n = 19); and the need for extended hours and increased staff (n = 16). The top 3 enablers were clear communication with patients (n = 27), awareness of the benefits of geriatric rehabilitation (n = 24) and the need for education and resources to properly use the pathway (n = 15). Common barriers among patients and caregivers included lack of care coordination, overcoming some of their own specific challenges during their transition, gaps in the information they received before discharge, not knowing what questions to ask and lack of resources. Despite these barriers, patients were generally pleased with their transition from the hospital to geriatric rehabilitation. Conclusion We identified and described key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of a standardized pathway aimed at improving access to rehabilitative care for geriatric hip fracture patients.

Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England

“…It is evident from the current study, and others, that resources and funding is a key barrier to effective provision following hip fracture, particularly matching demand with physiotherapy staff capacity ( environmental context and resources ) [ 8–10 , 43 ]. Furthermore, challenges regarding recruitment and retention in community physiotherapy services is recognised as a further barrier to effective provision.…”

“…A lack of interventions targeting fear avoidance behaviours after hip fracture was highlighted as an implementation barrier to effective provision by physiotherapists. Addressing the psychological burden of injurious falls is well documented [ 46–50 ] and approaches designed to reduce fear of falling following hip fracture include psychoeducation and cognitive behavioural therapy for patients and carers ( emotion, beliefs about capabilities ) [ 43 ]. Once embedded in provision these approaches lead to reduced costs [ 49 ] and improvements in social integration, psychological wellbeing, self-efficacy and functional recovery [ 46 , 47 , 50 ].…”