Rath Santosh, Yadav Lalit, Tewari Abha, Chantler Tracey, Woodward Mark, Kotwal Prakash, Jain Anil, Dey Aparajit, Garg Bhavuk, Malhotra Rajesh, Goel Ashish, Farooque Kamran, Sharma Vijay, Webster Premila, Norton Robyn
The George Institute for Global Health, University of Oxford, Oxford, UK.
IGHI, Imperial College, Kensington, London, SW7 2AZ, UK.
Arch Osteoporos. 2017 Dec;12(1):55. doi: 10.1007/s11657-017-0344-1. Epub 2017 Jun 2.
Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India.
Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India.
This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework.
A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip fracture in India.
The development and implementation of national guidelines and standardized protocols of care for older people with hip fractures in India has the potential to improve both care and patient-related outcomes.
基于证据的管理可减少老年髋部骨折患者的死亡和痛苦。本研究调查了德里三家主要医院髋部骨折护理中的证据与实践差距、改善护理的潜在障碍和促进因素，从而确定在印度为老年髋部骨折患者实施最佳管理实践的因地制宜的干预措施。
老年髋部骨折是印度一个重大的公共卫生问题。本研究旨在记录当前的实践情况，确定采用最佳实践指南的障碍和促进因素，并为印度德里老年髋部骨折患者的管理提出改进建议。
这项混合方法观察性研究收集了印度德里三家主要公立三级医院的医疗服务提供者、患者、护理人员的数据以及病历。招募了所有年龄≥50岁、经X线确诊为髋部骨折且在10周内入院的患者。在入院、出院和受伤后30天收集患者数据。对医疗服务提供者进行了11次关键 informant 访谈和4次焦点小组讨论。计算关键定量变量的描述性数据。使用行为改变轮框架对定性数据进行分析和解释。
在招募期间，三家参与研究的医院共确定了136例髋部骨折患者，其中74例（54%）为男性，62例为女性，只有85例（63%）入院接受治疗，平均年龄为66.5岁（标准差11.9）。其中，30%的患者在入院后48小时内接受了手术，95%的患者在入院后39天内接受了手术，两名（3%）患者在受伤后30天内死亡。据医疗服务提供者称，资源不足和过度拥挤妨碍了对髋部骨折患者的充分护理。他们一致认为印度需要基于方案的髋部骨折管理。
制定和实施印度老年髋部骨折患者的国家指南和标准化护理方案有可能改善护理和与患者相关的结局。
