26 Introducing the Sherpa Model for Managing Multi-Morbidity to Trainee GPS: Outcomes and Relevance to Elderly CareÂ

Background

Primary care trainees are traditionally taught to use a consultation model which focuses on eliciting the patients’ main reason for consulting “today”. As the number of patients with multi-morbidity increases, this approach is often inappropriate or unhelpful. Patients can be left without an understanding of their interacting health issues. The SHERPA model provides a biopsychosocial framework for consulting patients with multi-morbidity. We aimed to examine the responses to this model when integrated into a training programme for newly registered GPs.

Methods

Sixteen participants provide qualitative data on their experience and follow-up use of SHERPA. Four hours of teaching were observed. Twenty-four feedback templates on training (n = 18) and SHERPA application (n = 6) were collected. Individual semi-structured one-to-one interviews were conducted with trainees (n = 5) and trainers (n = 3). Data were transcribed and, using the Framework approach, systematically analysed focussing on the trainees’ reaction to the teaching sessions and their ability to use the SHERPA consultation model.

Results

Participants engaged well with the teaching sessions, enjoying the scenarios and bringing observations from their own experience. Five participants went on to apply SHERPA successfully with their patients. Barriers to using this approach were: not seeing appropriate patients with multi-morbidities (due to current placement or patient type); time; lack of confidence and familiarity; concern about missing important immediate clinical issues; and viewing the approach as “in addition” rather than key to shared decision-making.

Conclusion

The SHERPA model was viewed as a helpful addition by trainee GPs, although practical issues, fears and not seeing it as their priority for their case-mix, limited their application of it. Regular support from trainers, where trainees reflect on their experience of using SHERPA, could increase their confidence and familiarity with this method. These findings suggest that SHERPA may be relevant to other specialities such as geriatric medicine, where multi-morbidity is common.

52 I’m on the Floor and Can’t Get up and it’s Really Annoying: A Qualitative Investigation of Patient and Staff Perceptions of Options for Getting up From the Floor Following A Fall

Background

Falls are the most common reason for ambulance call-outs resulting in non-conveyance. Even in the absence of injury, only half of those who have fallen can get themselves up off the floor. Many remain there for over an hour, increasing complications risks.

It is feasible to teach people techniques to help get themselves off the floor, yet these techniques are rarely taught. To date, there are no published data on attitudes towards teaching and learning these techniques. Our study aimed to investigate patient, carer and staff attitudes towards seeking help and using techniques to get-up following a fall.

Methods

A qualitative focus group and semi-structured interviews were conducted with 28 participants, including community-dwelling older people who had experienced a non-injurious fall, carers, physiotherapists, occupational therapists, paramedics and community first responders.

Data were transcribed and analysed systematically using the Framework approach. A stakeholder group of falls experts and patients advised during analysis.

Results

The data highlighted three areas contributing to an individual’s capability to get-up following a fall: the environment (physical and social); physical ability; and degree of self-efficacy (attitude and beliefs about their own ability). These factors influenced each person’s capability to manage their fall response.

Staff described how they balance their responsibilities, prioritising the individual’s immediate needs; this leaves limited time to address capability in the aforementioned three areas. Paramedics, routinely responding to falls, only receive training on getting-up techniques from within their peer-group. Therapists are aware of the skillset to breakdown the getting-up process, but, with limited time, select who to teach these techniques to.

Conclusion

Neither therapists nor ambulance service staff routinely teach all those at risk of falling strategies on how to get-up. Interventions to positively impact on capability to get-up following a fall should include strategies that address the environment, physical ability and self-efficacy.