Department of Rheumatology, Doctor Negrin University Hospital, Las Palmas de Gran Canaria, Spain.
Bone Metabolism Unit, Department of Internal Medicine, "Virgen Macarena" University Hospital, Seville, Spain.
Arch Osteoporos. 2020 Apr 25;15(1):63. doi: 10.1007/s11657-020-0693-z.
The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain.
To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures.
A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated.
Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC.
The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.
制定西班牙骨折联络服务（FLS）与初级保健（PC）协调的最佳实践框架（BPF），以改善脆性骨折患者的护理连续性。
指导委员会从 7 个西班牙 FLS 和相关的 PC 医生和护士中选择专家参加最佳实践研讨会。选择标准是具有确定的拥护者的活跃 FLS 以及与医院相关的 PC 中心的先前联系。研讨会的主要目的是审查西班牙当前的 FLS 实践及其与 PC 的整合。然后生成了一份包含流程、工具、角色和指标的 BPF 文件。
西班牙 FLS 由医生/护士组成的多学科团队组成，但其他专业人员和 PC 工作人员的参与度较低。评估和治疗策略差异很大。达成了四项预期标准：（1）FLS-PC 沟通的有效渠道；（2）FLS 临床报告的最低内容及其向 PC 的传递；（3）FLS 基线就诊后 3 个月的依从性监测；（4）PC 随访。建议的关键绩效指标是（a）FLS-PC 沟通次数，包括共识协议；（b）确认 PC 收到 FLS 报告；（c）收到 FLS 报告后 PC 安排医疗/护理预约；（d）PC 培训课程的数量。
BPF 为西班牙 FLS-PC 协调提供了一种全面的方法，以促进脆性骨折患者的护理连续性并改善二级预防。未来，BPF 建议的实施和绩效指标跟踪将成为最佳 FLS 实践的基准。
