Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care.

BACKGROUND: Identifying frailty is key to providing appropriate treatment for older people at high risk of adverse health outcomes. Screening tools proposed for primary care often involve additional workload. The electronic Frailty Index (eFI) has the potential to overcome this issue. AIM: To assess the feasibility and acceptability of using the eFI in primary care. DESIGN AND SETTING: Pilot study in one suburban primary care practice in southern England in 2016. METHOD: Use of the eFI on the primary care TPP SystmOne database was explained to staff at the practice where a comprehensive geriatric assessment (CGA) clinic was being trialled. The practice data manager ran an eFI report for all patients (n = 6670). Date of birth was used to identify patients aged ≥75 years (n = 589). The eFI was determined for patients attending the CGA clinic (n = 18). RESULTS: Practice staff ran the eFI reports in 5 minutes, which they reported was feasible and acceptable. The eFI range was 0.03 to 0.61 (mean 0.23) for all patients aged ≥75 years (mean 83 years, range 75 to 102 years). For CGA patients (mean 82 years, range 75 to 94 years) the eFI range was 0.19 to 0.53 (mean 0.33). Importantly, the eFI scores identified almost 12% of patients aged ≥75 years in this practice to have severe frailty. CONCLUSION: It was feasible and acceptable to use the eFI in this pilot study. A higher mean eFI in the CGA patients demonstrated construct validity for frailty identification. Practice staff recognised the potential for the eFI to identify the top 2% of vulnerable patients for avoiding unplanned admissions.

Community matrons' experience as independent prescribers.

Community matrons prescribe medications and treatments for arguably the most complex patients in the community setting, yet little is known about their experiences of prescribing. Drug events and inappropriate prescribing are known to account for around 16% of hospital admissions. With a remit of reducing unplanned admissions to hospital, it is important to understand community matrons' experiences as prescribers and to examine the role of prescribing in fulfilling this agenda with consideration given to the adequacy of the prescribing support available. In this study, a qualitative research design was used and a purposive sample of seven community matrons from the south of England took part in the study. Semi-structured interviews were carried out and analysed using Braun and Clarke's six phases of thematic analysis. The findings show that community matrons consider prescribing-related knowledge to be essential in fulfilling their role and that the ability to prescribe speeds patient access to medicines. In some instances it may be instrumental in preventing hospital admission. Community matrons prescribe a limited range of medicines regularly, while referring to GPs for other prescribing that they consider outside their competency. Community matron prescribers mostly access their support from GPs and this is considered adequate in supporting them in their prescribing role.