Researchers have designed a new tool designed to help GPs assess which older people are the most frail and vulnerable.
Since July this year, identifying and managing patients with frailty has been in the GP contract. The new tool helps GP surgeries provide better care to the most vulnerable patients, improve health service planning and potentially make better use of resources.
The eFI tool was developed by Dr Andrew Clegg from the University of Leeds and tested by Dr Lynn Lansbury of the University of Portsmouth. Lynn trialled the tool in a GP practice to demonstrate how it works successfully in a busy primary care setting. The electronic frailty index (eFI) uses 36 indicators of frailty using routine data already held on GP databases. These include conditions such as anaemia, diabetes, heart and kidney problems, mobility issues and even social vulnerability. The tool uses the codes that GPs regularly assign to these conditions and flags up those patients who are at the most risk. It identifies those older people might be living with mild, moderate and severe frailty who are at increased risk of future nursing home admission, hospitalisation, longer length of hospital stay, and mortality.
The pilot showed that running the eFI report was quick and simple and could identify patients with a high frailty score in just a few minutes.
Dr Lansbury said: “The tool was developed last year but had not been applied in a real setting so I ran a live trial to demonstrate that it would benefit GPs and their patients. We all know how busy GPs are and I was aware they may be reluctant to adopt a new tool with all the administrative implications without evidence it would work.
“The pilot showed that running the eFI report was quick and simple and could identify patients with a high frailty score in just a few minutes. It was also more thorough. As well as identifying patients that the GPs were expecting to see, it also revealed other patients not previously identified as at risk. By identifying the most vulnerable patients the GPs are better able to support and treat them, which may improve their quality of life and could reduce unplanned admissions to hospital and care homes.”
The number of people in the United Kingdom over 85 years of age is anticipated to double between 2010 and 2030 and around 10 per cent are living with frailty. Frailty is associated with poor or deteriorating health including increased disability, admissions to hospital and care homes and mortality. However, while frailty is the result of a physical decline during a lifetime, it is neither a certainty of ageing nor inevitable and may be improved with the right help.
As well as identifying patients that the GPs were expecting to see, it also revealed other patients not previously identified as at risk. By identifying the most vulnerable patients the GPs are better able to support and treat them, which may improve their quality of life and could reduce unplanned admissions to hospital and care homes.
Dr Clegg said: “Implementing the eFI as part of routine primary care practice could help improve the care of older people with frailty, through a holistic approach to their overall health conditions, quicker referrals and signposting to local authority and voluntary services.” The eFI has been made freely available to every general practice in England as part of a national implementation project.
Dr Lansbury’s research, Use of the electronic Frailty Index in primary healthcare: a pilot study, is published this month in the British Journal of General Practice.
Dr Clegg’s original paper, Development and validation of an electronic frailty index using routine primary care electronic health record data, was published in 2016 in the journal Age and Ageing.
Implementing the eFI as part of routine primary care practice could help improve the care of older people with frailty, through a holistic approach to their overall health conditions, quicker referrals and signposting to local authority and voluntary services.