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Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups

INTRODUCTION: More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). Frailty is an incre...

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Autores principales: Green, Jonathan, Kirby, Kim, Hope, Suzy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The College of Paramedics 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706767/
https://www.ncbi.nlm.nih.gov/pubmed/33328809
http://dx.doi.org/10.29045/14784726.2018.12.3.3.23
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author Green, Jonathan
Kirby, Kim
Hope, Suzy
author_facet Green, Jonathan
Kirby, Kim
Hope, Suzy
author_sort Green, Jonathan
collection PubMed
description INTRODUCTION: More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). Frailty is an increasingly relevant concept/diagnosis and ambulance services are well positioned to identify frailty and influence the ‘care pathways’ through which patients are directed (thereby influencing health outcomes). Throughout the South Western Ambulance Service NHS Foundation Trust, a mandatory training session regarding frailty was delivered to clinical personnel in 2017 and frailty assessment tools are available on the electronic Patient Clinical Record. AIM: To explore and gain insight into the current knowledge, practice and attitudes of ambulance clinicians regarding frailty and patients with frailty. METHODS: Two focus groups of ambulance clinicians (n = 8; n = 9) recruited from across the South Western Ambulance Service NHS Foundation Trust were held in October 2017. Focus group discussions were analysed thematically. RESULTS: Knowledge of conceptual models of frailty, appropriate assessment of patients with frailty and appropriate care pathways varied substantially among focus group participants. Completion of the ‘Rockwood’ Clinical Frailty Scale for relevant patients has become routine. However, conflicting opinions were expressed regarding the context and purpose of this. The Timed-Up-and-Go mobility assessment tool is also on the electronic Patient Clinical Record, but difficulties regarding its completion were expressed. Patient management strategies ranged from treatment options which the ambulance service can provide, to referrals to primary/community care which can support the management of patients in their homes, and options to refer patients directly to hospital units or specialists with the aim of facilitating appropriate assessment, treatment and discharge. Perceptions of limited availability and geographical variability regarding these referral pathways was a major feature of the discussions, raising questions regarding awareness, capacity, inter-professional relationships and patient choice. CONCLUSION: Knowledge, practice and attitudes of ambulance staff, with regard to frailty, varied widely. This reflected the emerging nature of the condition, both academically and clinically, within the ambulance profession and the wider healthcare system.
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spelling pubmed-77067672020-12-15 Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups Green, Jonathan Kirby, Kim Hope, Suzy Br Paramed J Service Evaluation INTRODUCTION: More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). Frailty is an increasingly relevant concept/diagnosis and ambulance services are well positioned to identify frailty and influence the ‘care pathways’ through which patients are directed (thereby influencing health outcomes). Throughout the South Western Ambulance Service NHS Foundation Trust, a mandatory training session regarding frailty was delivered to clinical personnel in 2017 and frailty assessment tools are available on the electronic Patient Clinical Record. AIM: To explore and gain insight into the current knowledge, practice and attitudes of ambulance clinicians regarding frailty and patients with frailty. METHODS: Two focus groups of ambulance clinicians (n = 8; n = 9) recruited from across the South Western Ambulance Service NHS Foundation Trust were held in October 2017. Focus group discussions were analysed thematically. RESULTS: Knowledge of conceptual models of frailty, appropriate assessment of patients with frailty and appropriate care pathways varied substantially among focus group participants. Completion of the ‘Rockwood’ Clinical Frailty Scale for relevant patients has become routine. However, conflicting opinions were expressed regarding the context and purpose of this. The Timed-Up-and-Go mobility assessment tool is also on the electronic Patient Clinical Record, but difficulties regarding its completion were expressed. Patient management strategies ranged from treatment options which the ambulance service can provide, to referrals to primary/community care which can support the management of patients in their homes, and options to refer patients directly to hospital units or specialists with the aim of facilitating appropriate assessment, treatment and discharge. Perceptions of limited availability and geographical variability regarding these referral pathways was a major feature of the discussions, raising questions regarding awareness, capacity, inter-professional relationships and patient choice. CONCLUSION: Knowledge, practice and attitudes of ambulance staff, with regard to frailty, varied widely. This reflected the emerging nature of the condition, both academically and clinically, within the ambulance profession and the wider healthcare system. The College of Paramedics 2018-12-01 2018-12-01 /pmc/articles/PMC7706767/ /pubmed/33328809 http://dx.doi.org/10.29045/14784726.2018.12.3.3.23 Text en © 2018 The Author(s) https://creativecommons.org/licenses/by/2.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Service Evaluation
Green, Jonathan
Kirby, Kim
Hope, Suzy
Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title_full Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title_fullStr Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title_full_unstemmed Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title_short Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
title_sort ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups
topic Service Evaluation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706767/
https://www.ncbi.nlm.nih.gov/pubmed/33328809
http://dx.doi.org/10.29045/14784726.2018.12.3.3.23
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