Orthopedic Department of the Bulovka Hospital, Faculty of Medicine 1, Charles University, Prague, Czech Republic.
Department of Epidemiology, Faculty of Medicine 3, Charles University, Prague, Czech Republic.
Arch Osteoporos. 2017 May 18;12(1):49. doi: 10.1007/s11657-017-0346-z.
Despite individual recommendations on osteoporosis management in patients after hip fracture surgery, addressed by orthopedic surgeons to Czech general practitioners, the patients remained undiagnosed and untreated because of provider-level barriers to post-fracture secondary prevention.
The goal of the study was to assess whether an individual recommendation on osteoporosis treatment addressed to a hip fracture patient's GP would lead to better osteoporosis management.
Two groups of patients who suffered hip fractures and were treated at the Orthopedic Department were evaluated. In 111 patients, general recommendations on osteoporosis treatment and fracture prevention were provided in a discharge report addressed to the GP. In the second group, 96 patients were provided individually with a detailed written set of recommendations on osteoporosis examination, treatment, and fracture prevention, which was also provided in the discharge report. A questionnaire to assess the provided care was mailed to the patients 5.3 ± 1.2 months of discharge. Those patients who did not return the questionnaires were contacted by phone.
The questionnaires were received from 44% and 49% of patients from the general and detailed recommendation groups, respectively. Along with the phone call, we were able to contact 78 (70.3%) and 68 (70.8%) patients from the general and detailed recommendation groups, respectively. GPs secured osteoporosis evaluation in 14.6% of the patients. Calcium supplementation and vitamin D supplementation were newly provided in 42.7 and 36.4% of the patients, respectively. Anti-resorptive therapy was newly provided in 8.3% of the patients. No significant differences between the groups were observed in osteoporosis evaluation, calcium and vitamin D supplementation, and anti-osteoporosis treatments. Out of 207 patients, further examination or treatment was requested by 45 patients (21.7%); 75 patients (36.2%) declared no interest in further care.
Recommendations on osteoporosis management addressed to Czech GPs after surgical fracture management had little effect on treatment. As the anti-osteoporotic preparations can only be prescribed by specialists, the availability of necessary examinations and treatment is limited by the motivation of GPs. Consequently, the implementation of Fracture Liaison Services to help close the care gap may be limited in the absence of participation by Czech GPs.
尽管骨科医生向捷克全科医生提出了针对髋部骨折手术后患者的骨质疏松管理的个体化建议，但由于提供者在骨折后二级预防方面存在障碍，这些患者仍未得到诊断和治疗。
本研究的目的是评估针对髋部骨折患者的全科医生的骨质疏松治疗个体化建议是否会导致更好的骨质疏松管理。
评估了在骨科病房接受治疗的两组髋部骨折患者。在 111 例患者中，在给全科医生的出院报告中提供了骨质疏松治疗和骨折预防的一般建议。在第二组中，96 例患者收到了关于骨质疏松检查、治疗和骨折预防的详细书面建议，并在出院报告中提供了这些建议。在出院后 5.3±1.2 个月，向患者邮寄了一份评估所提供护理的调查问卷。未寄回问卷的患者通过电话联系。
一般建议组和详细建议组分别有 44%和 49%的患者收到了问卷。通过电话联系，我们能够联系到一般建议组和详细建议组分别有 78（70.3%）和 68（70.8%）例患者。全科医生对 14.6%的患者进行了骨质疏松评估。分别有 42.7%和 36.4%的患者新接受了钙补充剂和维生素 D 补充剂。分别有 8.3%的患者新接受了抗吸收治疗。在骨质疏松评估、钙和维生素 D 补充以及抗骨质疏松治疗方面，两组之间没有观察到显著差异。在 207 例患者中，有 45 例（21.7%）患者要求进一步检查或治疗；75 例（36.2%）患者表示对进一步护理不感兴趣。
针对骨科医生的髋部骨折手术后患者的骨质疏松管理建议对治疗的影响很小。由于抗骨质疏松药物只能由专科医生开具，因此必要的检查和治疗的可及性受到全科医生积极性的限制。因此，在没有捷克全科医生参与的情况下，实施骨折联络服务来帮助缩小护理差距的实施可能会受到限制。
