Keywords: Primary health care, frailty, care planning, continuity, qualitative research.

Background:

Vulnerable, older people often have complex healthcare needs that are difficult to address in an ordinary primary care setting. The intervention trial “Secure And Focused primary care for older pEople” (SAFE), includes early identification and assessment of these patients to assure proactive healthcare with care agreements based on person-centred patient goals and care planning. The SAFE project is registered at https://clinicaltrials.gov (identifier: NCT05706272).

Research questions:

The aim of this qualitative study is to explore physicians’ experiences of proactive work and care planning for vulnerable, older people at high risk of frailty in a Swedish primary care setting.

Method:

Individual semi structured interviews were conducted with 20 physicians working at 13 different primary healthcare care centres (PHCC) enrolled in the SAFE trial. Analysis of the interviews was made through qualitative content analysis without predetermined categories (Graneheim et Lundman, 2004).

Results:

Physicians’ experiences of working with the SAFE model in elder care teams in a primary care setting generated three categories: SAFE – Who is it for?, where physicians share their opinions regarding the structure and implementation of the SAFE work model in their primary healthcare centres; Cornerstones for a safe relationship, describing the importance of patient participation and healthcare continuity and accessibility: and Person-centred care and individual goals, emphasizing the significance of individualized proactive care planning.

Conclusions:

According to the study participants a structured work model such as the SAFE working model could support early identification of high-risk individuals, enable assessments and guide proactive interventions toward those with the greatest needs. Furthermore, the introduction of a mutual care agreement within the SAFE model represented a new tool, integrating patients’ preferences, values, and goals, an approach that, despite being challenging to formulate, often enhanced patient involvement. However, the risk of increased workload at the PHCCs must be considered.

Points for discussion:

Is a team based, proactive care model for older adults at risk of frailty feasible to implement in European primary care?

How do you view the physician’s role in the early identification and care of vulnerable older adults?

How and to what extent are care plans used in primary care across different European countries?