GAPcare: The Geriatric Acute and Post-Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data
GAPcare: The Geriatric Acute and Post-Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data
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DOI：
10.1111/jgs.16210
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发表时间：
2019-10-17
影响因子：
6.3
通讯作者：
Merchant, Roland C.
中科院分区：
文献类型：
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作者：
Goldberg, Elizabeth M.;Marks, Sarah J.;Merchant, Roland C.
我们的目的是描述一种新的多学科团队跌倒预防干预措施，用于在急诊科（ED）寻求护理的老年人，评估其可行性和可接受性，并回顾其启动过程中的经验教训。设计：单盲随机对照试验。两名城市学术急诊科参与者：65岁或以上的成年人（n = 110）在跌倒后7天内到急诊科就诊。参与者被随机分为常规护理组（UC）和干预组（INT）。INT组的参与者接受了由药剂师提供的简短药物治疗管理会议和由物理治疗师（PT）进行的跌倒风险评估和计划。INT参与者被转介到门诊服务（例如，家庭安全评估，门诊PT）。我们使用参与者、护理者和临床医生调查，以及电子健康记录审查，来评估干预的可行性和可接受性。结果在110名参与者中，中位年龄为81岁，67%为女性，94%为白人，16.3%有认知障碍。在INT组的55名参与者中，除1名外，其余均接受了药学咨询（98.2%）；PT咨询率为83.6%。药学组的中位会诊时间为20分钟，PT组为20分钟。INT组的ED住院时间没有增加：UC为5.25小时，INT为5.0小时（P < .94）。接受老年急性及急性后跌倒预防干预（GAPcare）后，100%的参与者和97.6%的临床医生推荐进行药学咨询，95%的参与者和95.8%的临床医生推荐进行PT咨询。结论：这些发现支持了GAPcare模型在ED中的可行性和可接受性。未来计划进行一项更大规模的随机对照试验，以确定GAPcare是否可以减少老年人的复发性跌倒和就诊。
OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single-blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults.