Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review

Ben R Davies; Helen Baxter; James Rooney; Phillip Simons; Ann Sephton; Sarah Purdy; Alyson L Huntley

doi:10.3399/bjgpopen18X101325

Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review

BJGP Open. 2018 Apr 10;2(1):bjgpopen18X101325. doi: 10.3399/bjgpopen18X101325. eCollection 2018 Apr.

Authors

Ben R Davies¹, Helen Baxter¹, James Rooney², Phillip Simons³, Ann Sephton⁴, Sarah Purdy⁵, Alyson L Huntley⁶

Affiliations

¹ Senior Research Associate, Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
² Senior Project Manager, NHS South, Central and West Commissioning Support Unit, Bristol, UK.
³ Clinical Evidence Fellow, NHS South Gloucestershire Clinical Commissioning Group, Warmley, UK.
⁴ Deputy Clinical Chair and Lead for Emergency and Urgent Care and Community Health Services, NHS South Gloucestershire Clinical Commissioning Group, Warmley, UK.
⁵ Professor of Primary Health Care, Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁶ Research Fellow, Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Abstract

Background: The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment.

Aim: To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use.

Design & setting: A rapid review involving a systematic search of Medline and Medline In-Process.

Method: Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005-June 2016.

Results: The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings.

Conclusion: Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission.

Keywords: frailty assessment; geriatric assessment; hospital admission; primary heath care.