Coordinator-based systems for secondary prevention in fragility fracture patients

Springer Science and Business Media LLC - Tập 22 - Trang 2051-2065 - 2011
D. Marsh1, K. Åkesson2, D. E. Beaton3,4, E. R. Bogoch3,5, S. Boonen6, M.-L. Brandi7, A. R. McLellan8, P. J. Mitchell9, J. E. M. Sale3,4, D. A. Wahl10
1Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
2Department of Orthopedics, Skåne University Hospital Malmö, Lund University, Sweden
3Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
4Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
5Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
6Division of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental Medicine, Leuven University, Leuven, Belgium
7Department of Internal Medicine, University of Florence, Florence, Italy
8Western Infirmary and University of Glasgow, Glasgow, UK
9School of Health, Faculty of Education, Health and Sciences, University of Derby, Derby, UK
10International Osteoporosis Foundation, Nyon, Switzerland

Tóm tắt

The underlying causes of incident fractures—bone fragility and the tendency to fall—remain under-diagnosed and under-treated. This care gap in secondary prevention must be addressed to minimise both the debilitating consequences of subsequent fractures for patients and the associated economic burden to healthcare systems. Clinical systems aimed at ensuring appropriate management of patients following fracture have been developed around the world. A systematic review of the literature showed that 65% of systems reported include a dedicated coordinator who acts as the link between the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Coordinator-based systems facilitate bone mineral density testing, osteoporosis education and care in patients following a fragility fracture and have been shown to be cost-saving. Other success factors included a fracture registry and a database to monitor the care provided to the fracture patient. Implementation of such a system requires an audit of existing arrangements, creation of a network of healthcare professionals with clearly defined roles and the identification of a ‘medical champion’ to lead the project. A business case is needed to acquire the necessary funding. Incremental, achievable targets should be identified. Clinical pathways should be supported by evidence-based recommendations from national or regional guidelines. Endorsement of the proposed model within national healthcare policies and advocacy programmes can achieve alignment of the objectives of policy makers, professionals and patients. Successful transformation of care relies upon consensus amongst all participants in the multi-disciplinary team that cares for fragility fracture patients.

Tài liệu tham khảo

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