Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review
Objective Identifying 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.Design A rapid realist review.Data sources Coc...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e054780.full |
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| author | David Reeves Thomas Blakeman Harm Van Marwijk Khulud Alharbi Jung Yin Tsang |
| author_facet | David Reeves Thomas Blakeman Harm Van Marwijk Khulud Alharbi Jung Yin Tsang |
| author_sort | David Reeves |
| collection | DOAJ |
| description | Objective Identifying 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.Design A rapid realist review.Data sources Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.Eligibility criteria for selecting studies We considered all types of empirical studies describing interventions targeting frailty in primary care.Analysis We 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.Results Our 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.Conclusion There 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 number The published protocol for the review is registered with PROSPERO (CRD42019161193). |
| format | Article |
| id | doaj-art-29059de0ecf6433798ce875336400943 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-29059de0ecf6433798ce8753364009432025-01-24T19:55:10ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-054780Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist reviewDavid Reeves0Thomas Blakeman1Harm Van Marwijk2Khulud Alharbi3Jung Yin Tsang4Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK5 University of Manchester, Manchester, UKDivision of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UKNational Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, Manchester, UKCentre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UKObjective Identifying 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.Design A rapid realist review.Data sources Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.Eligibility criteria for selecting studies We considered all types of empirical studies describing interventions targeting frailty in primary care.Analysis We 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.Results Our 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.Conclusion There 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 number The published protocol for the review is registered with PROSPERO (CRD42019161193).https://bmjopen.bmj.com/content/12/6/e054780.full |
| spellingShingle | David Reeves Thomas Blakeman Harm Van Marwijk Khulud Alharbi Jung Yin Tsang Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review BMJ Open |
| title | Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review |
| title_full | Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review |
| title_fullStr | Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review |
| title_full_unstemmed | Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review |
| title_short | Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review |
| title_sort | understanding the implementation of interventions to improve the management of frailty in primary care a rapid realist review |
| url | https://bmjopen.bmj.com/content/12/6/e054780.full |
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