Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review

Abstract

ObjectiveIdentifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care.DesignA rapid realist review.Data sourcesCochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.Eligibility criteria for selecting studiesWe considered all types of empirical studies describing interventions targeting frailty in primary care.AnalysisWe followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation.ResultsOur primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need.ConclusionThere remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence.PROSPERO registration numberThe published protocol for the review is registered with PROSPERO (CRD42019161193).

Current frailty knowledge, awareness, and practices among physicians following the 2022 European consensus document on Frailty in Cardiology

“… 10 Deliberate and targeted resource allocation that are additionally adaptable to patient-specific frailty may produce more effective and sustainable implementations (Graphic Abstract). 5 Therefore, identifying the particular needs of cardiology subspecialties may be essential for future frailty implementation research on top of CVD disease-specific recommendations [see Supplement (Annex 1) of the ESC Frailty in Cardiology consensus document]. 3 …”

“… 3 , 4 Frailty was recognized as heterogeneous and population specific 4 ; therefore, a comprehensive, unselected approach may disproportionately consume resources for assessments rather than the actual intervention implementation. 5 Identifying specific patient and physician requirements may instead enable a more effective, sustainable, longer-term implementation. 5 …”

“… 5 Identifying specific patient and physician requirements may instead enable a more effective, sustainable, longer-term implementation. 5 …”

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

“…However, we recommend individual-patient data meta-analysis to reliably examine whether patient level factors, such as patient complexity or index disease, moderate the effectiveness of different interventions needed. Furthermore, realist reviews could shed further light into the mechanisms of action and implementation of transitional care interventions …”

Series: Practical guidance to qualitative research. Part 7: Qualitative evidence synthesis for emerging themes in primary care research: Scoping review, meta-ethnography and rapid realist review

“…Finally, for example, during the COVID-19 pandemic, we learned that the traditional ways of generating evidence, such as lengthy systematic reviews, must be complemented with rapid reviews [ 6 ]. When researchers tailor the scope and purpose of a rapid review to the evidence request of primary care [ 7 ], they can generate the necessary context-sensitive evidence within a short period [ 8 ].…”