Perceptions of physicians on the barriers and facilitators to integrating fall risk evaluation and management into practice

Abstract

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.

Design: Qualitative study using a semi-structured interview.

Participants: Primary care providers who received an academic outreach visit.

Approach: 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.

Conclusion: 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.