155Home Visits: A New Screening Tool For Frailty? A Retrospective Study

Abstract

Introduction: In primary care, home visits are performed when a clinician determines that a patient is unable to attend surgery. Anecdotally, many of these patients are Frail. Current screening tools for Frailty such as PRISMA‐7, Timed up‐and‐go Test (TUGT), and Gait speed have varying sensitivities (0.83‐0.99) and specificities (0.62‐0.83)1. However, screening and coding Frailty as a diagnosis is not routine in general practice. This study assessed whether a clinicians judgement of the need for a home visit could in itself, form a new screening tool for Frailty. Method: A retrospective analysis was performed on 470 over 65‐year‐old patients registered at a surgery in Devon. Patients were divided into: Home visit group (n = 85) with two subgroups consisting of Patients who were under Proactive Case Management (PCM) (n = 42) Patients not under PCM (n = 43) Control group (n = 385); randomised sample of patients (n = 71) with similar baseline characteristics, not requiring a home visit Patient records were analysed by two researchers to see whether a frailty syndrome was present. Researchers were blinded to each other's results. The mean data from both researchers was statistically analysed in Microsoft Excel to give sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: In the control arm, eight patients had a frailty syndrome present. Twenty‐six frail patients were identified in the PCM group (Sensitivity 0.78 and specificity 0.80, PPV 0.62, NPV 0.90 p = 0.001). Twenty‐one patients were identified in the Non PCM group (Sensitivity 0.74, specificity 0.75, PPV 0.49, NPV 0.90, p = 0.01). Combined PCM/non PCM group: sensitivity 0.86 specificity 0.63, PPV 0.55, NPV 0.90 p < 0.00001. Conclusion: The results show that the need for a home visit is as good a screen for frailty as other screening tools. Furthermore, it does not require any additional time to perform. Knowledge of this screening tool should alert clinicians on home visits to the possibility of Frailty as a co‐existing diagnosis. As well as increasing confidence in diagnosis and coding of Frailty, it will significantly improve management of the frail elderly.