Case-Finding for Complex Chronic Conditions in Persons 75+ (C5-75)
Case-Finding for Complex Chronic Conditions in Persons 75+ (C5-75) enables family practices to rapidly screen patients 75 years of age and older for frailty and its associated conditions, with minimum training and equipment. The C5-75 program supports patients to maintain their health, quality of life and community living for as long as possible.
C5-75 was developed by the family health team at the Centre for Family Medicine in Kitchener, Ontario in 2012 and tested in 19 local family practices. The target group is patients aged 75 and older who are in a family practice group with shared electronic health records and who have been screened as frail.
Based on the Fried frailty phenotype criteria, C5-75 examines gait speed and hand grip strength to identify frail older adults who may be at higher risk of health destabilization. Together, these two tests were found to be a sensitive and specific proxy for the full Fried frailty phenotype for identifying those who are frail, while being faster to administer and resource-light in primary care.
The six-month community pilot project engaged 14 health service providers and 11,819 patients within an urban family practice setting in Kitchener, Ontario. Community staff, such as pharmacists, were trained to complete C5-75 Level 1 screening in addition to their prerequisite medication review duties.
The project team measured patients’ satisfaction levels and found that the mean score was 4.5 out of 5 (“very satisfied”). Pharmacy staff perceived the screening process to be feasible and acceptable, identifying screening time-related concerns in only two cases (4%). Eighteen family healthcare providers highlighted the usefulness of C5-75 in their frailty assessments of patients.
C5-75 is designed to proactively identify unrecognized or sub-optimally treated co-existing conditions. The program includes appropriate interventions with the goal of averting medical crises for patients that result in emergency department visits, hospitalization and early transition into long-term care.
This is one of the innovations being implemented as part of our Advancing Frailty Care in the Community Collaborative.