A cluster randomised controlled trial to evaluate the effectiveness of an integrated general practice fall prevention process compared with usual care on GP practice change and the rate of falls in older people residing in the community

1) An algorithm/decision tool is used to facilitate GPs in identifying, assessing and managing patients at risk of falling who are presenting to GP practices. To facilitate integration of the iSOLVE algorithm, face-to-face, one-hour academic detailing will be offered to GPs involved. Further, an electronic clinical decision support tool will be offered to GP practices involved. This electronic tool is developed as part of the iSOLVE project to integrate the processes into general practice systems and software to facilitate workflow. The decision making tool is adapted from STEADi, a primary care resource for fall prevention developed by the Centres for Disease Control in the United States, using the American Geriatrics Society’s Clinical Practice Guidelines, and has been updated using the Cochrane Database on community fall prevention. 2) Identifying older people: People aged 65 years and over who have had a fall will be identified through auditing GP practice database for patients’ over 65 years and presentation to GP practice for an appointment. 3) Fall risk identification: The patients will be invited to complete the ‘Stay Independent’ brochure in the GP practice waiting room prior to their GP appointment. This will provide an initial screening of risk factors to alert the GP. 4) Fall risk assessment: Patients who have identified a risk factor as per the ‘Stay Independent’ brochure will have the risk factor assessed by a GP. 5) Fall risk management: The GP will tailor a management plan based on the patient’s risk factor by referring to the algorithm, clinical decision tool and referral pathway developed as part of the iSOLVE project. Depending on the algorithm this may trigger further assessment by the GP such as a medication review or hypotension or dizziness. The GP will initiate an appropriate referral, based on the algorithm, to local fall prevention services for example exercise professional for prescription of strength and balance exercise, occupational therapist for home safety intervention, pharmacy medication reviews, Stepping On fall prevention programs or cataract surgery. GPs are encouraged to follow up on subsequent usual visits or addition visits if needed at the discretion of the GP. The GPs will tailor the duration of each consultation as appropriate for the GP and the patient. At the end of 12 months, the patients will be asked what fall prevention activities (e.g. exercise, home safety adaptations, medication review, cataract extraction) have been recommended by their GP and have been undertaken by them. 6) As part of the wider project, the iSOLVE team will engage with fall prevention service providers within the Northern Sydney Medicare Local (NSML) catchment area (study area) to facilitate referral pathways with GP practices. Education workshops will also be offered to fall prevention service providers in the study area.