21 January 2021

An Assessment Instrument For Primary Care

Material for this article is from Leon Geffen's webinar.
 “It has been a pleasure to work with Raisoft over the past couple of years. You have been a wonderful support to our research institute, in terms of allowing us to develop our research protocols and our data collection. Which has resulted in a number of publications" - Leon Geffen

At the end of 2020, Raisoft held a webinar series to celebrate our 20th anniversary. We had partners from all over the world both in attendance and presenting on various topics. Our partner Leon Geffen, of the Samson Institute For Aging Research (SIFAR), spoke about his experience working with Raisoft solutions. Our software has allowed them to administer interRAI self-assessments as part of their research in the 4 most commonly spoken languages in South Africa, and translate the output reports in real-time from one language to another.

Leon is a family physician with a particular interest in the care of elder persons and has been an interRAI fellow since about 2013.

- I'm based in Cape Town, with a great office in Mamre. It's a rural town about 60 kilometers from Cape Town, made up of 9000 people. This is a nurse-led clinic, there are no doctors on-site, and the nearest primary care hospital is about 15 kilometers away and they serve the needs of the community.

Leon and his team have been using the interRAI Check-Up Self-Report(CU-SR) to census all the people over the age of 60 in town. They went door-to-door assessing the people of Mamre, using the CU-SR. He and his team have been able to collect a wealth of data that allowed them to review the health and well-being of the community.

- It’s a very fine instrument to use for assessing the health and wellbeing of communities, as well as working at a primary care level.

What is the CU-SR?

The CU-SR is a self-evaluation form that assesses the ability, health, and well-being of the elderly. The screener offers clinicians a tool for a more effective and extensive assessment of the care needs. It contains 90 questions that can be administered through phone, online or in-person meetings. When the evaluation is completed, reports are created that document ability and health and make the individual's resources and weaknesses visible. Once you have finished the evaluation, a report is created that documents: decision-making ability and communication, state of mind and well-being, physical and social activities, nutrition status, economic vulnerability, use of health care services, health status, and disease, and ADL/IADL – ability. 

Why develop this instrument?

Many health care workers are not attuned to the needs of older people. And when there's a lack of trust by with the doctors or nurses there that are treating them, then there's a lack of health care utilization and people seek health care elsewhere.

-And what we know, is that when there is a longer-term relationship with one single health care provider, there's a much better perception of care and better care that arises.

Leon then discussed his reasoning behind the need to develop an instrument like the CU-SR.

-The reason for developing an instrument of this nature is, that we know that a lot of the instruments are very heavy in terms of data collection, and they often require high levels of skill to administer them. Usually, in order to administer these instruments, you should be nurse practitioners, occupational therapists, physiotherapists, doctors, nurses, or health care personnel. However, a lot of the questions we ask in these instruments could potentially be answered by people who have not trained health care personnel. So the question we asked ourselves is, could we take some of these instruments and all the questions within the instruments and simplify them to the point where we would be able to get high-quality data, which could inform their health and well-being or assessment of people who are not receiving complex care, but maybe in a community or maybe presenting at a primary care level.

- It's a relatively simple language. It can be self-administered or administered by someone with a reasonable level of literacy. And it can be implemented in a low resource setting and in the primary care setting. Low resource settings that only occur in low and middle-income countries that occur across the globe once again in the high-income countries, too, that there are areas of relative poverty or relative lack of services like rural areas, etc? So we think that this is an instrument that could be very useful in these areas and at a primary care level.

Why use it in primary care?

The one area that has not had much in the way of assessment instruments, is at the primary care level. This is what originally piqued Leon’s interest, pushing him to think if we could develop an instrument to use at the primary care level. The time that people can spend in a primary care setting is very short. And the doctors or nurses who work in primary care, don't have the time to fill in these instruments.

- These patients have a short time with either the doctor or the nurse and therefore cannot have complex instruments administered to them. We know that doctors have more than 200 consultations a week. They have about 10 minutes for each consultation.

With age, you end up seeing many different physicians at many different locations. They often see multiple service providers that often change their care settings. They go from seeing physicians in a clinic, into a hospital, into a post-acute care setting, possibly into palliative care, sitting into a nursing home or long term care setting. And the key to all of this is that we need to be able to integrate and coordinate the care that people are receiving.

Full Webinar: 

You can watch the full webinar here