Preparing the workforce for frailty in primary and community healthcare

Purpose

The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary assessment that identifies the medical, psychosocial, and functional needs of older people. This service evaluation considers the impact of training allied health professionals (AHPs) and community nurses to undertake a CGA assessment in primary and community settings.

Approach

A group of 30 AHPs and community nurses completed a training module on frailty and the geriatric comprehensive assessment. Ten days of classroom teaching was supplemented by 76 hours of supervised practice. Participants were assessed using an observed structured clinical examination, reflective essay and supervised peer case reviews. Learners' progression was tracked using an electronic geriatric competency framework.

A mixed methods approach combined survey and focus group data to evaluate the educational programme. Focus groups with participants discussed the motivation to participate, confidence level, learning aims and potential barriers to their learning. Students were also asked how they intended to incorporate new skills into their practice. A focus group with AHPs investigated their learning needs and how a CGA approach could be incorporated into their clinical practice. Survey data used Likert scales to evaluate the relevance, depth and potential to change clinical practice after each classroom day. Anonymised free text answers allowed learners to comment on the programme.

Outcomes

In general, participants were motivated to learn new skills to improve their patient care. Teaching sessions were scored as relevant, in-depth and likely to change their clinical practice. The main barriers to participation was the time pressure involved in balancing training with service provision. The mixed cohort of AHPs and community nurses provided peer learning and support which was highly valued by the participants.

Focus group data with AHPs identified four main motivating factors for participation; recognising the deteriorating older patient, assessment skills including history taking and clinical examination, a greater overview of medical conditions and drugs that impact on patient function and improved communication with GPs. The AHPs described their educational needs in comparison to community nurses. These learning needs included interpreting investigations (urinalysis, blood sugar readings, blood pressure measurement and blood test results) and their understanding of the medication review. Practitioners described how they were often asked to see complex older patients at home as part of admission avoidance programmes and described how they planned to use their CGA skills in this setting.

Implications

This evaluation suggests that it is feasible to train AHPs and community nurses to undertake a CGA assessment. Practitioners valued learning these CGA skills and planned to incorporate them into their clinical roles.

Expected patient benefits include the early identification of frailty, production of an individualised care plan and improved patient satisfaction with the community teams. Outcomes for workforce may include improved team flexibility, resource allocation, and job satisfaction. It is anticipated that the training will improve integration across community teams and communication with general practitioners.

Further research is needed to understand the effectiveness (participant attainment, change in clinical practice and cost-benefit analysis) of geriatric competencies education programme for AHPs and community nurses.

Fund acknowledgements

This researcher was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust.

Additional notes

This work was presented at Physiotherapy UK 2018.