Real-World Implementation of PRISMA-7 and Clinical Frailty Scale for Frailty Identification and Integrated Care Activation: A Cross-Sectional Study in Northern Italian Primary Practice

Background/Objectives: Frailty screening is crucial for identifying vulnerable older adults who may benefit from interventions. However, implementation of screening in primary care and integration into personalised care pathways remains limited. This study examined feasibility of a two-step frailty screening approach combining PRISMA-7 and Clinical Frailty Scale (CFS). The study assessed PRISMA-7 cut-offs’ impact on frailty classification, CFS agreement, and activation of integrated domiciliary care. Methods: This cross-sectional study was conducted in Northern Italy. General practitioners screened patients aged ≥75 years using the PRISMA-7 tool; if the result was positive (score ≥3), the Clinical Frailty Scale (CFS) was subsequently applied. Descriptive statistics, group comparisons, correlation analyses, and logistic regression models were employed to evaluate the predictors of frailty and activation of integrated domiciliary care. Comparisons were made for PRISMA-7 cut-off values ≥3 and ≥4. Results: Among the 18,658 patients evaluated using PRISMA-7, 46.0% were identified as frail with a threshold of ≥3 and 28.8% with ≥4. In a subset of 7,970 patients assessed using both the PRISMA-7 and Clinical Frailty Scale (CFS), CFS confirmed frailty (score ≥5) in 48.3% of patients at a PRISMA-7 cut-off of 3 and 68.2% at a cut-off of 4. Female sex predicted frailty by CFS, whereas male sex was correlated with frailty at the PRISMA-7 cut-off of 3. Rural location was correlated with frailty by PRISMA-7 but showed an inverse relationship with frailty by CFS. Integrated domiciliary care began in 14.2% of the patients meeting the clinical criteria, with a higher frequency in rural areas. Concordance between PRISMA-7 and CFS increased with patient age, and at a cut-off of 4. Conclusions: Two-step frailty screening using PRISMA-7 and CFS is viable for primary care. Using a PRISMA-7 cut-off score of ≥4 may reduce frailty overestimation, enhance congruence with clinical assessments, and reduce sex-related bias. These findings support incorporating structured screening into personalized care planning and refining frailty tools to improve equity and effectiveness.