Perspectives of Australian GPs on tailoring fall risk management: a qualitative study.

Falls among older people are highly prevalent, serious and costly, and translation of evidence about falls prevention needs to occur urgently. GPs can identify older people at risk of falling and put preventative measures in place before a fall. Because GPs are key to identifying older people at risk of falls and managing falls risk, this study explored how GPs adapted to the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) process to embed evidence-based falls prevention strategies within primary care, and whether and how they changed their practice. A theoretically informed qualitative study using normalisation process theory was conducted in parallel to the iSOLVE trial to elicit GPs' views about the iSOLVE process. Data were coded and a thematic analysis of interview transcripts was conducted using constant comparison between the data and themes as they developed. In all, 24 of 32 eligible GPs (75%) from general practices located in the North Sydney Primary Health Network, Australia, were interviewed. Six themes were identified: (1) making it easy to ask the iSOLVE questions; (2) internalising the process; (3) integrating the iSOLVE into routine practice; (4) addressing assumptions about patients and fall prevention; (5) the degree of change in practice; and (6) contextual issues influencing uptake. The iSOLVE project focused on practice change, and the present study indicates that practice change is possible. How GPs addressed falls prevention in their practice determined the translation of evidence into everyday practice. Support tools for falls prevention must meet the needs of GPs and help with decision making and referral. Fall prevention can be integrated into routine GP practice through the iSOLVE process to tailor fall risk management.

Influences on general practitioner referral to allied health professionals for fall prevention in primary care.

OBJECTIVE: To explore influences on referral for fall prevention from general practitioners (GPs) to allied health professionals (AHPs) to better equip AHPs engage with GPs regarding fall prevention. METHODS: Qualitative, semi-structured interviews with GPs (n = 24), practice nurses (n = 3) and AHPs (n = 15) and field notes were analysed inductively using constant comparative methods. RESULTS: Three main themes regarding influences on GP referral to AHPs for fall prevention were identified as follows: GPs' knowledge of AHPs; The "reliable and good" AHP; and Patient feedback-Patient choice. Three-way communication and trust between GP, patient and AHP underpinned each of these themes. CONCLUSIONS: Strategies for encouraging GP referral include AHPs personally contacting GPs to explain their services; writing to GPs about every patient seen; and being aware that interprofessional relationships are based on trust and take time to develop. GPs and AHPs are encouraged to communicate directly rather than relying on patients to convey verbal information.

Making fall prevention routine in primary care practice: perspectives of allied health professionals.

BACKGROUND: While there is strong evidence that fall prevention interventions can prevent falls in people aged 65 and over, translating evidence into routine practice is challenging. Research regarding how allied health professionals (AHPs) respond to this challenge is limited. As part of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project, this study aimed to explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice. METHODS: In-depth qualitative interviews were conducted with fifteen AHPs who had attended evidence-based workshops associated with the iSOLVE project. AHPs had backgrounds in physiotherapy, occupational therapy, exercise physiology and podiatry. Interviews explored how fall prevention was being incorporated into routine practice and the factors that influenced routinisation, including the project workshops. Thematic analysis was used to analyse the data. RESULTS: We found fall prevention was valued in practice and recognised as complex. AHPs worked through challenges relating to clients (multi-morbidity, complex living situations, client motivation), challenges working alongside other health professionals (understanding respective roles/overlapping roles, sense of competition, communication) and challenges associated with funding systems perceived as complicated and constantly changing. Despite these challenges, AHPs were adopting strategies for integrating fall prevention routinely. The iSOLVE workshops were perceived as important in supporting existing practice and in providing strategies to enhance practice. CONCLUSIONS: Policy makers, program managers, educators and AHPs can adopt strategies identified in this research for routinising fall prevention such as being alert that falls are common, asking every client about falls, having processes for assessing clients for fall risk, and having structured and evidence-based programs to work with clients on fall prevention. Adapting and streamlining funding systems are also important for facilitating fall prevention work.

Men's perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men's Sheds, Australia.

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group-based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi-structured interviews during June and July 2015 which were audio-recorded and transcribed. Data were coded and analysed using constant comparative methods. Over-arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male-friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action.

Purpose and pleasure in late life: Conceptualising older women's participation in art and craft activities.

The fourth age, as the last stage of life, represents a final challenge to find personal meaning in the face of changing capacities, illness and disability. Participation in valued activities is important for sustaining interest in life and has been associated with enhanced health and well-being. Art and craft activities are a popular form of participation amongst women in late life with growing international interest in the potential for these types of activities to maintain health and well-being and address problems of social isolation. Drawing on open text comments from 114 women enrolled in the Australian Longitudinal Study on Women's Health and in-depth interviews with 23 women all aged in their eighties, this paper explores the nature of older women's participation in art and craft activities and conceptualises links between participation in these activities and health and well-being in late life. Participation in art and craft activities is complex and dynamic, comprising cognitive and physical processes infused with emotion and occurs in the context of social relationships, physical spaces, physical ailments and beliefs about the value of the activities. By participating in art and craft activities, older women find purpose in their lives, contributing to their subjective well-being whilst helping and being appreciated by others. They develop a self view as enabled and as such take on new art and craft challenges, continue to learn and develop as art and craft makers and remain open to new possibilities.

Painting pictures and playing musical instruments: change in participation and relationship to health in older women.

AIM: To explore how changed participation in painting pictures or playing a musical instrument is related to change in physical and mental health in older women. METHOD: Women enrolled in the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health were surveyed in 2005 and 2008. Changed participation in painting pictures or playing a musical instrument was considered in relation to changes in social activity, social support, health status and health-related quality of life. RESULTS: Data were available for 5058 women. Improvements in instrumental activities of daily living (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.2; P = 0.004) and role limitations due to emotional factors (OR 1.6, 95% CI 1.0-2.5; P = 0.002) were associated with starting participation. Decline in mental health-related quality of life (OR 4.1, 95% CI 2.3-7.2; P < 0.0001) was associated with stopping. CONCLUSION: Changed participation was associated with change in functional capacity and tied to emotional well-being.

Influencing population health performance: feedback from managers, population health staff and clinicians on the NSW Population Health Standards for Area Health Services.

The NSW Population Health Standards for Area Health Services have recently been introduced in NSW to assist area health services assess and improve performance in population health. Greater Western Area Health Service was the pilot site for trialling the Standards as a self-assessment tool. Following self-assessment, managers, population health staff and clinicians were asked for feedback. Staff were either interviewed or participated in a group discussion. Consulting with staff who would be required to use the Standards in the long term was seen as important for facilitating implementation across the area health service. The Standards were seen as credible and potentially beneficial, especially in raising the profile of population health work and encouraging population-based and integrated approaches.

Influencing population health performance: introduction of standards for area health services in New South Wales.

Standards are a yardstick against which performance can be assessed and improved. Standards are well established in healthcare settings; however, population health standards have only recently been developed for area health services in NSW. This paper describes international and Australian population health standards, and presents the results of a pilot evaluation of the NSW Population Health Standards for Area Health Services against the Greater Western Area Health Service performance requirements. The findings revealed that the standards relating to the work of specialist population health staff feature in performance requirements; however the standards requiring the contribution of other health service staff do not. Population health standards have the potential to guide the health system towards population health goals.

The immunisation cold chain. Why is it so hard to get right?

BACKGROUND: Although the standards for vaccine storage required for accreditation of general practices, and the Guidelines for Australian Immunisation are widely available, all research to date suggests that in Australia compliance with these standards has not been readily achieved. OBJECTIVE: The New South Wales Central West Division of General Practice (NSWCWDGP) and the Public Health Unit of the New South Wales Mid Western Area Health Service (NSW MWAHS) worked together from 1999 to 2001 to produce an intervention that would gather information about current vaccine storage, and provide practical help to storage sites which were not complying with accepted standards. DISCUSSION: Cooperation between a general practice division and the public health unit can deliver coverage of 100% of vaccinators in a large geographic region. We have demonstrated that the lack of a designated person to take on ultimate responsibility for vaccines at a site is associated with less chance of achieving safe storage. Persistent difficulty in 'getting it right' has been documented. One new measure we have suggested and trialled is the installation of affordable commercial thermostats in the domestic refrigerators that are now widely used. Another is the piloting of a general practice division administered mailout program of temperature dataloggers to document the ongoing compliance of vaccine storage sites with accepted standards.