Chan Tom, de Lusignan Simon, Cooper Alun, Elliott Mary
Clinical Informatics, Department of Health Care Policy and Management, University of Surrey, Guildford, Surrey, United Kingdom.
Bridge Medical Centre, Three Bridges Road, Crawley, West Sussex, United Kingdom.
PLoS One. 2015 Aug 27;10(8):e0132146. doi: 10.1371/journal.pone.0132146. eCollection 2015.
Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture.
Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication.
This audit took place in 12 GP practices using 'before and after' cross-sectional extractions of anonymised routine data. We report, for females 50-74 years and ≥ 75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA), smoking, and body-mass index (BMI) and use of appropriate bone-sparing medication. We used Altman's test of independent proportions to compare before and after data.
Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059); the rate of DXA scans fell (1.8% to 1.4%; p = 0.002); recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively) with approximate doubling of the recording of smoking, and BMI (p<0.001 level). Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ≥ 75 years old (p<0.001). There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents.
A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial.
骨质疏松症及相关脆性骨折是一个重大的健康问题；在50岁以上的女性中更为常见。骨折联络护士已在二级医疗保健中广泛应用，以促进对脆性骨折的识别，并促进使用保骨药物以降低再次骨折的风险。
评估基层医疗骨折联络护士对骨质疏松症患者脆性骨折的检测及其使用保骨药物治疗的影响。
本次审计在12家全科医生诊所进行，采用“前后”横断面提取匿名常规数据。我们报告了50 - 74岁和≥75岁女性的社会经济剥夺指数、骨质疏松症患病率、脆性骨折记录、双能X线吸收测定法（DXA）、吸烟情况、体重指数（BMI）以及适当保骨药物的使用情况。我们使用阿尔特曼独立比例检验来比较前后数据。
骨质疏松症诊断记录从1.5%增至1.7%（p = 0.059）；DXA扫描率下降（从1.8%降至1.4%；p = 0.002）；骨折和脆性骨折记录增加了一倍多（分别从0.8%增至2.0%；p<0.001和从0.5%增至1.5%；p<0.001），吸烟和BMI记录也近似翻倍（p<0.001水平）。50至74岁女性的脆性骨折记录从8.8%升至15%，≥75岁人群从0.8%升至2.3%（p<0.001）。该服务似乎存在不公平现象，最不贫困的人群更有可能接受DXA扫描，而贫困程度较高的人群更有可能被开处保骨药物。
基层医疗中的骨折联络护士与一段时间内管理的改善相关。应在前瞻性试验中对卫生系统不同部门的联络护士进行测试。
