Promoting independence, health and well-being for older people: a feasibility study of computer-aided health and social risk appraisal system in primary care.

Autor: Walters K; Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK. K.walters@ucl.ac.uk., Kharicha K; Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK., Goodman C; Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, Hertfordshire, UK., Handley M; Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, Hertfordshire, UK., Manthorpe J; Social Care Workforce Research Unit, King's College London, Strand, London, WC2B 4LL, UK., Cattan M; University of Northumbria, Sutherland Building Newcastle-upon-Tyne, Newcastle, NE1 8ST, UK., Morris S; Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK., Clarke CS; Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK., Round J; Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK., Iliffe S; Department Primary Care & Population Health, University College London (UCL), Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
Jazyk: angličtina
Zdroj: BMC family practice [BMC Fam Pract] 2017 Mar 24; Vol. 18 (1), pp. 47. Date of Electronic Publication: 2017 Mar 24.
DOI: 10.1186/s12875-017-0620-6
Abstrakt: Background: With population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care.
Methods: Design: Feasibility study.
Setting: Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK) Participants: Random sample of patients aged 65 + years.
Intervention: The Multi-dimensional Risk Appraisal for Older people (MRA-O) system includes: 1) Postal questionnaire including health, lifestyle, social and environmental domains; 2) Software system generating a personalised feedback report with advice on health and wellbeing; 3) Follow-up of people with new concerning or complex needs by GPs or practice nurses.
Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation.
Results: Response rates to initial postal invitations were low (526/1550, 34%). Of these, 454/526 (86%) completed MRA-O assessments. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. A range of problems was identified by participants, including pain in last week (269/438, 61.4%), low physical activity (173/453, 38.2%), sedentary lifestyle (174/447, 38.3%), falls (117/439, 26.7%), incontinence (111/441 25.2%), impaired vision 116/451 (25.7%), impaired hearing (145/431, 33.6%), depressed mood (71/451, 15.7%), impaired memory (44/444 9.9%), social isolation (46/449, 10.2%) and loneliness (31/442, 7.0%). Self-rated health was good/excellent in 312/437 (71.4%), and quality of life and well-being were slightly above age-specific population norms. Implementation costs were low. Practices reviewed medical records of 143/454 (31.5%) of participants as a consequence of their responses, and actively followed up 110/454 (24.2%) of their patients.
Conclusions: A computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access. Widespread implementation of this approach would require work to address potential inequalities.
Databáze: MEDLINE
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