Drew S, Sheard S, Chana J, Cooper C, Javaid M K, Judge A
Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
Osteoporos Int. 2014 Oct;25(10):2427-33. doi: 10.1007/s00198-014-2775-5. Epub 2014 Jun 26.
There is variation in how services to prevent second fractures after hip fracture are organised. We explored this in more detail at 11 hospitals. Results showed that there was unwarranted variation across a number of aspects of care. This information can be used to inform service delivery in the future.
Hip fractures are usually the result of low impact falls and underlying osteoporosis. Since the risk of further fractures in osteoporotic patients can be reduced by between 20 and 70 % with bone protection therapy, the NHS is under an obligation to provide effective fracture prevention services for hip fracture patients to reduce risk of further fractures. Evidence suggests there is variation in service organisation. The objective of the study was to explore this variation in more detail by looking at the services provided in one region in England.
A questionnaire was designed which included questions around staffing, models of care and how the four components of fracture prevention (case finding, osteoporosis assessment, treatment initiation and adherence (monitoring) were undertaken. We also examined falls prevention services. Clinicians involved in the delivery of osteoporosis services at 11 hospitals in one region in England completed the questionnaire.
The service overview showed significant variation in service organisation across all aspects of care examined. All sites provided some form of case finding and assessment. However, interesting differences arose when we examined how these components were structured. Eight sites generally initiated treatment in an inpatient setting, two in outpatients and one in primary care. Monitoring was undertaken by secondary care at seven sites and the remainder conducted by GPs.
The variability in service provision was not explained by local variations in care need. Further work is now needed to establish how the variability in service provision affects key patient, clinical and health economic outcomes.
髋部骨折后预防二次骨折的服务组织方式存在差异。我们在11家医院对此进行了更详细的探究。结果显示，在护理的多个方面存在不必要的差异。这些信息可用于为未来的服务提供提供参考。
髋部骨折通常是由低冲击力跌倒和潜在的骨质疏松症导致的。由于通过骨保护疗法可将骨质疏松症患者再次骨折的风险降低20%至70%，英国国民医疗服务体系（NHS）有义务为髋部骨折患者提供有效的骨折预防服务，以降低再次骨折的风险。有证据表明服务组织存在差异。本研究的目的是通过考察英格兰一个地区提供的服务，更详细地探究这种差异。
设计了一份问卷，其中包括有关人员配备、护理模式以及骨折预防的四个组成部分（病例发现、骨质疏松症评估、治疗启动和依从性（监测））如何开展的问题。我们还考察了跌倒预防服务。英格兰一个地区11家医院中参与提供骨质疏松症服务的临床医生完成了问卷。
服务概述显示，在所考察的护理各个方面，服务组织存在显著差异。所有机构都提供了某种形式的病例发现和评估。然而，当我们考察这些组成部分的结构方式时，出现了有趣的差异。八个机构通常在住院环境中启动治疗，两个在门诊，一个在初级保健机构。七个机构由二级保健机构进行监测，其余机构由全科医生进行监测。
服务提供的差异无法用护理需求的局部差异来解释。现在需要进一步开展工作，以确定服务提供的差异如何影响关键的患者、临床和卫生经济结果。
