Implementing the National Frailty Policy in Singapore's Primary Care: A Pilot Feasibility Study of The Intrinsic Capacity ProMotion in PrimAry Care for The Frail Program (IMPACTFrail)
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 180
- 主要终点
- Qualitative study 1
研究概览
简要总结
The IMPACTFrail program is an intrinsic capacity (IC) identification and management program for mildly frail older adults. Specifically, it delivers the three-tier approach recommended in the National Frailty Strategy Policy Report. The program's core functions include the segmentation of older persons using the Clinical Frailty Scale (CFS) score followed by secondary IC screening for CFS 4 to 5 (Tier 1), follow-up clinical assessment to confirm IC losses (Tier 2) and needs-directed management and tracking of their health (Tier 3).
The investigator aims to conduct a multi-site feasibility study on a small group of older adult study participants (n=30 per polyclinic).
The feasibility study has a few components. First, a qualitative study will assess its feasibility (implementation, appropriateness, acceptability, practicality, adaptability) as perceived by older adults, healthcare providers, and healthcare administrators. Second, the investigator aims to collect process indicators to track its implementation progress. Third, program costs will be estimated. Fourth, the investigator will develop a logic model and theory of change, and cluster-specific detailed written program descriptions. Lastly, the investigator aims to triangulate the findings and assess the feasibility for larger-scale implementation. This study is guided by implementation science frameworks and guidelines for conducting feasibility studies.
详细描述
Background:
The broad goal for older adults is to age well and have healthy ageing. WHO defines healthy ageing as "the process of developing and maintaining the functional ability that enables wellbeing in older age." Functional ability is about having the capabilities that enable all people to be and do what they have reason to value.
Frailty is a clinically recognisable state whereby an older person's ability to cope with daily or acute stressors is compromised as a result of vulnerability from age-related deterioration in physiological reserves and function across multiple organ systems. Frailty is associated with negative health outcomes and is expected to increase in Singapore's ageing population. The National Frailty Strategy Policy Report published in 2023 serves to guide the Singapore Ministry of Health (MOH) Frailty Policy Implementation Workgroup in implementing the National Frailty Policy (NFP). One of the gaps identified in the report was the need for coordinated care and continuity of care across health and social service providers for frail older adults. To address this gap in Singapore's primary care setting, the IMPACTFrail program's core functions are to conduct segmentation of older people by using the Clinical Frailty Scale (CFS) score followed by secondary intrinsic capacity (IC) screening of six domains (locomotion, vision, hearing, vitality, cognition, psychological capacity) for CFS 4 and 5 (Tier 1), follow-up assessments based on IC deficits detected at screening (Tier 2), and coordination, management, and tracking (Tier 3). This study aims to co-develop IMPACTFrail's intervention components and implementation strategies in a small number of polyclinics and test its feasibility using implementation research in real-world local contexts.
Methods:
Prior to this pilot feasibility study, the investigators co-developed the innovation and implementation strategies among GERI, polyclinic cluster representatives, and implementers. This will be guided by the UK Medical Research Council's Framework (MRC) for developing and evaluating complex interventions and Framework of Actions for Intervention Development (FAID). Informal FGDs and interviews with stakeholders were conducted and the findings used to inform the development of the innovation. ERIC strategies will be selected to address CFIR barriers identified from the FGDs/interviews and specify and develop them.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 60 Years 至 100 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •being a patient of the polyclinic site
- •aged 60 years and above
- •Clinical frailty score (CFS) of 4 - 5
- •Not done comprehensive geriatric assessment (CGA) in the past 12 months (based on available medical records or self-report)
- •Not a current patient of geriatric specialist outpatient clinic (based on available medical records or self-report).
排除标准
- •Do not meet inclusion criteria above
- •Healthcare Staff (for qualitative study)
- •Inclusion Criteria:
- •aged 21 years and above
- •Involved in the IMPACTFrail program as an implementer and/or a healthcare administrator with authority to make implementation decisions.
- •Exclusion Criteria:
- •Do not meet inclusion criteria above
结局指标
主要结局
Qualitative study 1
时间窗: Mar 2025 - Feb 2026
What will be measured: Deviations to the intended execution of the programme and implementation strategies and reasons for changes made. How will it be measured: Via in-depth interviews (IDIs) and focus group discussions (FGDs) with healthcare administrators and healthcare providers. All participants for the qualitative study will be identified through purposive sampling. We will adopt the Rapid Qualitative Inquiry (RQI) approach in data analysis.
Qualitative study 2
时间窗: Mar 2025 - Feb 2026
What will be measured: Barriers/facilitators of implementing/receiving the programme and its implementation strategies. How will it be measured: Via in-depth interviews (IDIs) and focus group discussions (FGDs) with healthcare administrators, healthcare providers, and older adults. All participants for the qualitative study will be identified through purposive sampling. We will adopt the Rapid Qualitative Inquiry (RQI) approach in data analysis.
Qualitative study 3
时间窗: Mar 2025 - Feb 2026
What will be measured: Perspectives on the ability to deliver innovation with given resources (manpower, infrastructure, IT, others). How will it be measured: Via in-depth interviews (IDIs) and focus group discussions (FGDs) with healthcare administrators and healthcare providers. All participants for the qualitative study will be identified through purposive sampling. We will adopt the Rapid Qualitative Inquiry (RQI) approach in data analysis.
Qualitative study 4
时间窗: Mar 2025 - Feb 2026
What will be measured: Suggestions on how to improve the implementation of the programme for scalability and sustainability. How will it be measured: Via in-depth interviews (IDIs) and focus group discussions (FGDs) with healthcare administrators and healthcare providers. All participants for the qualitative study will be identified through purposive sampling. We will adopt the Rapid Qualitative Inquiry (RQI) approach in data analysis.
Programme cost
时间窗: Mar 2025 - Feb 2026
The aim is to inform the funding of resources (developmental cost e.g., training, new materials, innovation cost and cost of implementation strategies needed to scale up the programme). Programme costs will be derived by aggregating expenditures from financial statements on operating expenses, manpower, training, and equipment cost incurred, and obtaining the time spent by healthcare workers to actualise the delivery of the program.
Logic model and theory of change
时间窗: Mar 2025 - Feb 2026
What will be measured: The output is a single figure. We aim to depict a visual representation of the resources, key activities, outputs, outcomes, and plausible causal pathways connecting them.
Written programme description
时间窗: Mar 2025 - Feb 2026
What will be reported: The investigators will report the narrative detailed description of the programme. How will it be measured or reported: The frameworks used are TIDIER and AIMD.
Process indicators
时间窗: Mar 2025 - Feb 2026
What will be measured: Number of older adults with Clinical frailty scale (CFS) score 4-5, number of older adults who completed intrinsic capacity screening, number of older adults who actualised follow-up appointments. How will it be measured: Data collection will be from healthcare providers on the ground.
Fidelity of implementation strategy: Educational meetings, Part 1
时间窗: Mar 2025 - Feb 2026
What will be measured: Actor: Who executed the educational meetings. How will it be measured: Data collection will be from healthcare providers on the ground.
Fidelity of implementation strategy: Educational meetings, Part 2
时间窗: Mar 2025 - Feb 2026
What will be measured: Action target: Who attended the meetings How will it be measured: Data collection will be from healthcare providers on the ground.
Fidelity of implementation strategy: Educational meetings, Part 3
时间窗: Mar 2025 - Feb 2026
What will be measured: Temporality: Frequency of meetings How will it be measured: Data collection will be from healthcare providers on the ground.
Fidelity of implementation strategy: Educational meetings, Part 4
时间窗: Mar 2025 - Feb 2026
What will be measured: Dose: Number of meetings that each healthcare provider attended. How will it be measured: Data collection will be from healthcare providers on the ground.
Fidelity of implementation strategy: Educational meetings, Part 5
时间窗: Mar 2025 - Feb 2026
What will be measured: Action: Content (topics)/style (lecture, didactic) of educational meetings How will it be measured: Data collection will be from healthcare providers on the ground.
次要结局
未报告次要终点