• William C Chou, Mary E Tinetti, Mary B King, Kevin Irwin, and Richard H Fortinsky.
• Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. william.chou@aya.yale.edu
• J Gen Intern Med. 2006 Feb 1; 21 (2): 117122117-22.

BackgroundFalls are common, treatable, and result in considerable morbidity in older adults. However, fall risk factor evaluation and management targeted at high-risk patients is largely neglected in clinical practice.ObjectiveTo identify barriers and facilitators to the implementation of fall risk management by primary care providers.DesignQualitative study using a semi-structured interview.ParticipantsPrimary care providers who received an academic outreach visit.ApproachSelf-reported facilitators and barriers to evaluating and managing fall risk in older patients.ResultsPhysician factors, logistical factors, and patient factors intersect to either facilitate or impede fall risk evaluation and management by primary care providers. Physician factors include awareness, competing risks, appropriateness of referrals, training, and tie-in to familiar activities. Logistical factors include availability of transportation, time requirements of immobile patients, reimbursement, scheduling, family involvement, and utilization of other health care providers. Physicians' perceptions of patient factors include reporting, attitudes toward medication, and positive feedback.ConclusionStrategies to improve the adoption of fall risk evaluation and management in primary care should address the specific physician, logistical, and patient barriers perceived by physicians who had received an informative, motivational intervention to assess and manage falls among their patients.

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