Background: To meet the increasing demand for home healthcare in Japan, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24-hour home care services through the end of life.
Methods: A retrospective cohort study was conducted using the national database in Japan. Participants were ≥65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, enhanced HCSCs with or without beds. Each patient was followed up for 6 months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end-of-life care defined as in-home death. Multivariable logistic regression analyses were performed.
Results: The analysis included 160,533 patients, including 13,477, 64,616, 35,150, and 47,290 patients receiving regular home visits by general clinics, conventional HCSCs, enhanced HCSCs without beds, and enhanced HCSCs with beds, respectively. Compared to general clinics, the use of conventional HCSCs, enhanced HCSCs without beds, and enhanced HCSCs with beds was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56–1.69], 1.92 [1.84–2.00], and 1.81 [1.74–1.88] respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82–0.90], 0.82 [0.79–0.86], and 0.92 [0.88–0.96], respectively). Among 39,035 patients who died during the follow-up period, conventional HCSCs, enhanced HCSCs without beds, and enhanced HCSCs with beds had more in-home deaths (aOR [95% CIs] of 1.46 [1.33–1.59], 1.69 [1.54–1.85], and 1.53 [1.39–1.67] respectively) compared to general clinics.
Conclusions: HCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting further promotion of HCSCs (especially enhanced HSCSs) would be advantageous.

Our presentation will contribute to the ongoing professional development of the participants in several ways.
1. It will provide the participants with up-to-date knowledge and insight into the current status of home healthcare in Japan.
2. The reference to Japanese HCSC services may inspire participants to explore similar initiatives in their own countries, potentially leading to new ideas and innovations in their own healthcare systems.
3. We can discuss how to assess the effectiveness of a certain healthcare system using administrative claims data from epidemiological and statistical perspectives.

Frailty, associated with increasing age and characterised by diminished strength and function, often remains undetected. Presentations of frailty frequently occur when a seemingly minor event results in a significant health crisis and unecessary hospital admission, with substantial associated health care costs. Evidence suggests that targeted therapies may decrease the negative outcomes associated with being frail. In Australia frailty affects up to 25% of people aged ≥70 yet a standardised assessment of frailty amongst patients attending general practice is not routine. The Frail Scale, developed and validated internationally as a screening tool, requires five simple questions relating to fatigue, resistance, ambulation, illnesses, and weight loss to be answered to identify risk of frailty. Our audit of 313 patients aged ≥75 years who had completed annual health assessments in 11 Australian general practices, found only 2% had been assessed for all five Frail Scale components.
To facilitate use of the FRAIL scale, a FRAIL Scale Tool has been developed which can be built into the General Practice clinical support system. Our pilot study is investigating the 1) feasibility/adoption of the Tool by general practices recruited from two Australian regions (North Sydney/Brisbane South); 2) access to resources/referral options in the community to support identified need; 3) acceptability to providers/patients/carers of the risk of frailty assessment and management approach. The Tool has been adopted by 17 general practices recruited from the two regions and is a feasible, acceptable method to identify risk of frailty and provide management suggestions.
This study is providing an understanding of the services required in the community to support those who are at risk of frailty. A reduced burden to the hospital system, improved health outcomes and quality of life for older people are potential benefits of an effective tool used routinely in general practice to assess frailty risk.

1. Risk of frailty is not being routinely assessed in general practice
2. The Frail scale tool can be easily incorporated into the practice workflow.
3. Risk of frailty management resources and services are required to support the implementation.

Background: Enabling medical student contribution during primary care clinical placements can enhance student learning and quality of care for elderly patients in residential aged care facilities (RACF). This medical student RACF placement includes a learning task where students recommend improvements to resident care. The study aimed to identify these recommendations, measure their adoption and explore stakeholders’ perspectives on the program.
Methods: A mixed methods approach was adopted to audit student recommendations and their adoption into resident care, followed by semi-structured interviews with stakeholders in the educational program to determine attitudes, barriers and enablers to use of student recommendations.
Students completed a medical assessment of a resident during their RACF placement, summarising their recommendations in a letter to the resident’s general practitioner (GP). Three months after the time of recommendation, residents’ files were audited.
Semi-structured interviews with RACF staff and GPs were transcribed, coded using an inductive and iterative process of constant comparison, and thematically analysed to identify stakeholder perspectives.
Results: Forty residents and 43 students had recommendations audited. In total, 391 recommendations were made, and 77 recommendations were adopted. Medication recommendations were most common (47%), followed by allied health referrals (12%), lifestyle changes (10%) and GP review (10%).
Themes from the interview data included: benefits for residents and facility life; quality improvement from student involvement; barriers to stakeholder engagement, and identified opportunities for improvement to the program.
Discussion: Primary care placements in RACFs provide a unique opportunity to use an existing student learning task to feed into genuine quality improvements for care, and connecting the students with primary healthcare partners in a meaningful way enhances learning. This study gives insight into types of recommendations students make, and suggests strategies to maximise the benefits of student contributions.

1. Medical students make valuable contributions to health systems
2. Connecting students to primary care providers can improve quality of care
3. Residential aged care facilities have opportunities to include students to the benefit of their residents

Background: Botswana, like most African countries, lacks a well-established community-based comprehensive geriatric assessment programme (CGA). We intended to implement a CGA in the Mahalapye Health District (MHD), Botswana. This project provided training opportunities in community-oriented primary care (COPC) and CGA for the University of Botswana (UB) medical students (MS) and family medicine residents (FM-R).
Methods: This was a COPC initiative. In June 2020, UB Family Medicine academics met with a non-governmental organisation called "Ntshegetse-Ke-Go-Tshegetse" and MHD health professionals. The team implemented a CGA in MHD—a rural setting—that would target at-risk community-dwelling older adults (AR-CDOA). AR-CDOA patients were those over the age of 65 who had at least one geriatric syndrome. We derived the screening tool from the "Brief Assessment Tool for Screening Geriatric Syndromes." MS and FM-R screened older adults or reviewed AR-CDOA in the community in ten minutes. We established criteria for referring patients to relevant healthcare professionals. MS and FM-R organise health education, while volunteers help AR-CDOA with laundry, bathing, feeding, grocery shopping, and medication collection through the CGA.
Results: Every Thursday or Friday afternoon, MS or FM-R conduct home visits for AR-CDOA. Since the programme's inception, each of the 16 MS in an 8-week FM rotation and the 9 FM-R have had at least one home visit every four weeks.They provide health education once every eight weeks. Ten volunteers assisted the 124 AR-CDOA enrolled in the programme. During the COVID-19 outbreak, the team assisted AR-CDOA in obtaining vaccines and medications.

Conclusion: We implement CGA in MHD to provide community service and to assist MS and FM in practising CGA. We intend to expand this programme in the future to other family medicine training sites.

At the end of my presentation, attendees will
1. Appreciate a practical way for medical students and family medicine residents to learn about community-oriented primary care and comprehensive geriatric assessment.
2. Evaluate the implementation of a geriatric assessment healthcare programme involving academics, students, health professionals, and community resources such as non-governmental organisations and volunteers.
3. Consider ways that medical students and family medicine residents can help the community while learning specific skills like comprehensive geriatric assessment.

Objective：To test the effects of multidisciplinary team extended management on self-management behavior, self-efficacy, medication adherence, nutritional status, pain level, and to provide reference for the management of elderly osteoporosis patients in community.
Method: According to the inclusion and exclusion criteria, A total of 101 participants were randomized into experimental (n=52) and control groups (n=49) from June to December 2021 in community health service center. The experimental group implemented multidisciplinary team extension management mode and the control group adopted traditional management mode. All participants received the 1-year intervention, with data collected before and after the intervention, including evaluate self-management behavior, self-efficacy, medication adherence, nutritional status, pain level, and living quality.
Result: There were significant improvements in evaluate self-management behavior, self-efficacy, medication adherence, nutritional status, pain level after intervention in the experimental group. However, there was no significant improvement in living quality after intervention.
Conclusion：Multidisciplinary team extended management of elderly osteoporosis patients in the community had positive effects and provides a unique perspective of management of elderly osteoporosis patients in the community.

1. Multidisciplinary team
2. Extended management
3. Senile osteoporosis