Davidson Emily, Seal Alexa, Doyle Zelda, Fielding Kerin, McGirr Joe
School of Medicine, Sydney (Rural Clinical School Wagga Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia.
School of Medicine, Sydney (Rural Clinical School Lithgow), The University of Notre Dame Australia, Bowenfels, New South Wales, Australia.
Aust J Rural Health. 2017 Dec;25(6):362-368. doi: 10.1111/ajr.12355. Epub 2017 Jun 15.
Clinical guidelines recommend that patients who sustain a minimal trauma fracture (MTF) should receive a bone mineral density (BMD) scan and bisphosphonate (or equivalent) therapy if diagnosed with osteoporosis. A pilot fracture liaison service (FLS) was implemented in regional NSW to improve adherence to the guidelines.
Prospective cohort study with an historical control.
Primary care.
Control (n = 47) and cohort (n = 93) groups comprised patients consenting to interview who presented with a MTF to the major referral hospital 4 months before and 12 months after FLS implementation respectively.
Primary outcome measures were the rates of BMD scans and anti-osteoporotic medication initiation/review after MTF. Hospital admission data were also examined to determine death and refracture rates for all patients presenting during the study period with a primary diagnosis of MTF within 3 years of their initial fracture.
Although there was no improvement in BMD scanning rates, the reported rate of medication initiation/review after fracture was significantly higher (P < 0.05) in the FLS cohort. However, once adjusted for age, this association was not significant (P = 0.086). There was a lower refracture rate during the cohort period (P = 0.013), however, there were significantly more deaths (P = 0.035) within 3 years of initial fracture. When deaths were taken into account via competing risk regression, patients in the cohort period were significantly less likely to refracture than those in the control period (Hazard ratio = 0.576, P = 0.032).
A rurally based nurse-led FLS was associated with modest improvement after MTF. Consideration should be given to ways to strengthen the model of care to improve outcomes.
临床指南建议，发生轻微创伤性骨折（MTF）的患者若被诊断为骨质疏松症，应接受骨密度（BMD）扫描及双膦酸盐（或等效药物）治疗。新南威尔士州地区实施了一项试点骨折联络服务（FLS），以提高对这些指南的依从性。
采用历史对照的前瞻性队列研究。
初级保健机构。
对照组（n = 47）和队列组（n = 93）由同意接受访谈的患者组成，他们分别在FLS实施前4个月和实施后12个月因MTF到主要转诊医院就诊。
主要观察指标为MTF后BMD扫描率及抗骨质疏松药物起始/复查率。还检查了住院数据，以确定研究期间所有以MTF为主要诊断且在初次骨折后3年内就诊的患者的死亡率和再骨折率。
虽然BMD扫描率没有提高，但FLS队列中报告的骨折后药物起始/复查率显著更高（P < 0.05）。然而，在对年龄进行调整后，这种关联并不显著（P = 0.086）。队列期的再骨折率较低（P = 0.013），但初次骨折后3年内的死亡人数显著更多（P = 0.035）。通过竞争风险回归考虑死亡因素时，队列期患者再骨折的可能性显著低于对照期患者（风险比 = 0.576，P = 0.032）。
以农村地区护士为主导的FLS与MTF后的适度改善相关。应考虑加强护理模式以改善治疗效果的方法。
