Survey Results
Aim
The aim of the falls injury workforce survey was to gather information
from physicians and other health professionals about their level of awareness
of falls injury among older people and their knowledge of risk factors,
therapeutic interventions and prevention initiatives. The survey also
gathered information on workforce practices and priorities.
Issue/Project:
Data analysis of the Falls Prevention workforce survey has identified
a number of target areas for improving knowledge and practice in falls
prevention
amongst College Fellowship and other health professionals.
Preliminary
Background:
The Falls Prevention for Older People Program conducted thirteen national
workshops between February and May 2004 on falls injury risk factors
and strategic interventions. Approximately (30) physicians presented
sessions
at the workshops with (58) physicians and trainees and (232) other
health professionals attending the workshops.
A website for the promotion of the workshops was developed to provide general information on falls injury risk factors and interventions, including a workforce survey based on the questionnaire used in the pilot, and other project objectives (attachment 1). The Hunter Institute of Mental Health, an evaluation agency engaged by the RACP, assisted in devising the content of the survey with the aim of assessing the level of knowledge of falls risk factors and interventions amongst Fellows and other members of the medical workforce.
The web-based survey was completed by 106 respondents from the following
categories:
•
Physicians
•
GP’s
•
Nurses
•
Allied health workers
•
health promotion workers
•
managers
•
other
Data analysis of the workforce survey has identified a number of areas
for training and Continued Professional Development for College Fellowship
and other health professionals. In particular, gaps in knowledge and use
of effective intervention programs, screening tools, case conferencing
and aged care assessments have indicated the need for greater education
and promotion in these areas.
Data Analysis
Of the 116 respondents:
| • | Only 55% believed they had a sufficiently comprehensive understanding of falls in older persons. |
| • | 75% indicated they take falls histories from their older patients, and 49% of those who have a falls clinic in their region refer patients to one. For physicians alone this was significantly lower at 20%. |
| • | Knowledge of effective interventions was high for targeted exercise (83%), medication modification (81%), hip protectors and feet and footwear (84%), slightly less for vision (81%) and significantly less for nutritional supplements (56%). |
| • | Data relating to the use of different screening tools identified significant gaps in the use of effective falls interventions. MMSE was the most widely use screening tool amongst respondents (46%), followed by ‘Timed Up and Go’ (33%) and the Berg Balance Scale (26%). Other screening tools such as the Tinetti Mobility Score (13%), PPA (8%), FRAT (8%), and EFST (4%) were used significantly less. |
| • | Of the 8 screening tools mentioned, only 3 were identified by physicians as being utilised. They were MMSE, ‘Timed Up and Go’, and the Berg Balance Scale. |
| • | Only 33% of respondents were familiar with Medicare arrangements for case conferencing and aged care assessments. |
| • | 92% of respondents identified ‘prior knowledge’ as their source of information about falls risk factors and interventions; |
| • | 75% identified ‘consultations with other specialists’; 49% use clinical guidelines and 47% use internet sites. For physicians alone, 60% do not refer to the Clinical Guidelines as a source of information on falls. |
| • | Only 51% of respondents had reviewed an academic paper in the previous six months on falls. |
| • | Of the respondents, 96% demonstrated interest in attending a training workshop on falls. |
Discussion
The data analysis of the workforce survey has identified a number of areas
in which to focus falls prevention strategies and activities. As much
as 70% of physicians who responded believe they are not sufficiently
informed to have a comprehensive understanding of falls, representing
a significant opportunity for the RACP to improve to improve health outcomes
in older persons through education and training. In particular, there
is insufficient knowledge and use of screening tools and of Medicare
arrangements for case conferencing and aged care assessments. There is
also insufficient use of falls clinical guidelines.
The workforce survey also identified that 57% of health professionals use internet sites as a source of information on falls. The Falls Prevention website is therefore a useful tool for promoting evidence-based best practice, information on screening tools and promotion of clinical guidelines. It could also be used to assist in providing information on how to organise case conferences and aged care assessments.
‘Consultation with other specialists’ was also identified
as a common source on information of falls across the medical workforce.
It is particularly important that specialists within the falls community
have a sufficiently comprehensive
understanding of falls and of effective preventative interventions, as
this information is often drawn upon by other medical professionals. Specialists
therefore play an important role in informing the wider falls community
on falls prevention strategies.