scholarly journals 24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting

2021 ◽  
Author(s):  
Christian Hentschke ◽  
Martin Halle ◽  
Barbara Geilhof ◽  
Peter Landendoerfer ◽  
Wolfgang Blank ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Fall Prevention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Injurious Falls ◽  
Cluster Randomized

Abstract Background Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. Objective Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. Design and Setting In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156). Intervention and Measurements Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. Results After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). Conclusions In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.

scholarly journals P0842MANAGEMENT OF RENAL RISK PATIENTS AND THERAPEUTIC CHANGES AFTER DIAGNOSIS OF KIDNEY DISEASE IN PRIMARY CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emanuel Zitt ◽  
Hannelore Sprenger-Mähr ◽  
Karl Lhotta
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Risk ◽  
Kidney Disease ◽  
Statin Therapy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pressure Control ◽  
Risk Patients ◽  
Ras Blockers

Abstract Background and Aims Screening for chronic kidney disease (CKD) is proposed in high risk groups. Whether a new CKD diagnosis in general practice leads to improved patient management, is largely unknown. Method To answer this question and evaluate the kidney disease specific pharmacological care in renal risk patients, a screening study in patients at high risk for kidney disease was performed in the primary care setting in ten general practices in the state of Vorarlberg, Austria. General practitioners were provided with guidelines for the management of CKD with a focus on blood pressure control, RAS inhibition and use of statins. Results In total, 434 patients between age 35 and 77 were included (61% males, mean age 56±7 years, eGFR 86±15 ml/min, body mass index 31±6 kg/m, blood pressure 135±16/83±10 mmHg), of whom 80% had hypertension, 43% had diabetes and 42% were obese. RAS-blockers were already taken by 64% of patients, statins by 39%. A diagnosis of CKD (stage ≥G3 and/or ≥A2) was established in 73 patients (17%), 60% of them had diabetes. Compared to patients without CKD, CKD patients were already treated more often with RAS-blockers (78% vs 61%, p=0.005), whereas statin usage was comparable (44% vs 38%, p=0.3347). After CKD diagnosis, medical therapy was changed in 13 patients (18%). A RAS-blocker was initiated in two out of the 16 patients without a preexisting RAS-blocker (12.5%), the dosage was increased in one patient. Antihypertensive therapy was intensified adding amlodipine in seven patients (10%), and a statin was begun in six (15%) out of 41 statin-naive patients. In those without CKD after the screening, therapy was changed in 40 patients (11%). Compared to patients with CKD, fewer patients started a statin therapy (5% vs 15%, p=0.012) and were additionally treated with amlodipine (3% vs 10%, p=0.021) to optimize blood pressure control. Conclusion This study shows that in the primary care setting a great proportion of CKD patients are already on RAS-blockers, whereas the prescription rate for statins is low. A diagnosis of CKD led to a moderate increase in statin therapy, which leaves further opportunity for improvement. The reasons for this rather low use of statins in CKD patients need to be determined.

scholarly journals Fall Prevention in a Primary Care Setting

2016 ◽  
Author(s):  
Monika Siegrist ◽  
Ellen Freiberger ◽  
Barbara Geilhof ◽  
Johannes Salb ◽  
Christian Hentschke ◽  
...  
Keyword(s):  
Primary Care ◽  
Fall Prevention ◽  
Care Setting ◽  
Primary Care Setting

Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled trial

2017 ◽  
Vol 17 (11) ◽  
pp. 2157-2163 ◽  
Author(s):  
Chitima Boongird ◽  
Prasit Keesukphan ◽  
Soontraporn Phiphadthakusolkul ◽  
Sasivimol Rattanasiri ◽  
Ammarin Thakkinstian
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Fall Prevention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Controlled Trial ◽  
Exercise Program ◽  
Randomized Controlled ◽  
Home Based
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