General practitioner-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the ‘Living Well Assessment’ quality improvement project in Scotland

Background Evidence to support comprehensive geriatric assessment (CGA) in primary care for frail older people is limited.

Aim To evaluate a general practitioner (GP) led adapted CGA quality improvement project

Design & setting Multi-methods evaluation in a large practice in Midlothian in Scotland

Method The intervention was conducted by 10 GPs in a practice of approximately 11,000 patients, initially in the patient’s home, and then remotely (by telephone or video consultation) during the COVID-19 pandemic. Evaluation included a patient questionnaire, and qualitative interviews with GPs delivering the LWA, analysed by thematic analysis.

Results 165/220 (75%) patients responded to the survey of which 86% reported a ‘very good experience’ of the LWA. The method of delivery did not significantly influence this although most (59%) stated a preference for face-to-face consultation. For the 41% who preferred remote LWA, most (33%) preferred telephone to video consultation (8%). Problems in remote consultations related to technical issues (video), poor vision (video) or deafness (telephone/ video). GPs felt that home-based LWAs had real benefits but switching to remote during the pandemic had proven feasible. Concerns included potential increase in GP workload due to the LWA and whether it was an efficient use of GPs’ time.

Conclusions GP-led adapted CGA was feasible in a large practice, even during the pandemic, and highly valued by frail patients. Questions regarding efficient use of GPs’ time, effectiveness in terms of important patient outcomes and impact, and cost-effectiveness, requires further investigation in a larger study.