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Development of an integrated-care delivery model for post-fracture care in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature168468
Source
Osteoporos Int. 2006;17(9):1337-45
Publication Type
Article
Date
2006
Author
S B Jaglal
C. Cameron
G A Hawker
J. Carroll
L. Jaakkimainen
S M Cadarette
E R Bogoch
H. Kreder
D. Davis
Author Affiliation
Department of Physical Therapy, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada. susan.jaglal@utoronto.ca
Source
Osteoporos Int. 2006;17(9):1337-45
Date
2006
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Continuity of Patient Care - organization & administration
Delivery of Health Care, Integrated - organization & administration
Focus Groups
Fractures, Bone - etiology - prevention & control
Health Services Research
Humans
Interprofessional Relations
Models, organizational
Ontario
Osteoporosis - complications - diagnosis - therapy
Patient Education as Topic
Referral and Consultation - organization & administration
Abstract
The purpose of this study was to develop an integrated-care model for patients at highest risk for osteoporosis, those with a low-trauma fracture. Specific objectives were to describe the current processes and patterns of post-fracture care in hospitals in Ontario; to examine health-care professional and patient awareness of osteoporosis and the roles and responsibilities of various organizations and health care professionals; and to identify barriers and facilitators and obtain feedback on the model.
In 2002, questionnaires were completed for 178 eligible hospitals.
Only 65% of hospitals inform primary-care physicians of a fracture for all patients and only 4% indicated that they provide information about osteoporosis. The main themes that emerged from the four patient focus groups (n=21) were lack of continuity of care, the absence of a link between the fracture and osteoporosis by both patients and health care providers, and need for information. Most participants agreed that something was needed to prompt their primary-care physician to investigate for osteoporosis. The four physician focus groups (n=26) identified a role for orthopaedic surgeons to flag cases.
From 34 key informant interviews with community-based organizations, we found a lack of integration between health care professionals who provide fracture care and those who provide osteoporosis management and fall prevention. Based on these data, we developed an integrated local-resource-based post-fracture care model, which we obtained feedback on at a stakeholder consultation workshop. The model focuses on improving emergency department/fracture clinic communication, emphasizes the need for follow-up investigation by family physicians for osteoporosis, and incorporates other health care professionals and a telemedicine multidisciplinary osteoporosis clinic. We are currently evaluating whether this model leads to an increase in appropriate investigation of and treatment for osteoporosis in patients with low-trauma fractures.
PubMed ID
16821001 View in PubMed
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Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial.

https://arctichealth.org/en/permalink/ahliterature132786
Source
Osteoporos Int. 2012 Jan;23(1):87-95
Publication Type
Article
Date
Jan-2012
Author
S B Jaglal
O S Donescu
V. Bansod
J. Laprade
K. Thorpe
G. Hawker
S R Majumdar
L. Meadows
S M Cadarette
A. Papaioannou
M. Kloseck
D. Beaton
E. Bogoch
M. Zwarenstein
Author Affiliation
Toronto Rehabilitation Institute, Toronto, ON, Canada. susan.jaglal@utoronto.ca
Source
Osteoporos Int. 2012 Jan;23(1):87-95
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bone Density Conservation Agents - therapeutic use
Case Management - organization & administration
Delivery of Health Care, Integrated - organization & administration
Drug Utilization - statistics & numerical data
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Ontario
Osteoporosis - diagnosis - drug therapy
Osteoporotic Fractures - prevention & control
Outcome Assessment (Health Care)
Primary Health Care - organization & administration
Sex Factors
Abstract
We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management.
To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control).
A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was 'appropriate' management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications.
Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3-4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0-7.0).
A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists.
Notes
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PubMed ID
21779817 View in PubMed
Less detail