Servicio de Reumatología, Hospital Universitari Parc Taulí (UAB), Sabadell, Spain.
Servicio de Reumatología, Hospital del Mar, Barcelona, Spain.
Arch Osteoporos. 2021 Feb 27;16(1):48. doi: 10.1007/s11657-021-00878-w.
The study aimed to achieve expert consensus to optimize secondary fracture prevention in Spain. Relevant gaps in current patient management were identified. However, some aspects were considered difficult to apply. Future efforts should focus on those items with greatest divergences between importance and feasibility.
To establish a Spanish multidisciplinary expert consensus on secondary fracture prevention.
A two-round Delphi consensus was conducted, guided by a Scientific Committee. The 43-item study questionnaire was designed from a literature review and a subsequent multidisciplinary expert group (n = 12) discussion. The first-round questionnaire, using a 7-point Likert scale, assessed the experts' opinion of the current situation, their wish for items to happen, and their prognosis that items would be implemented within 5 years. Items for which consensus was not achieved were included in the second round. Consensus was defined as ≥ 75% agreement or ≥ 75% disagreement. A total of 102 experts from 14 scientific societies were invited to participate.
A total of 75 (response rate 73.5%) and 69 (92.0%) experts answered the first and second Delphi rounds, respectively. Participants mean age was 51.8 years [standard deviation (SD): 10.1 years]; being 24.0% rheumatologists, 21.3% primary care physicians, 14.7% geriatricians, 8.0% internal medicine specialists, 8.0% rehabilitation physicians, and 8.0% gynecologists. Consensus was achieved for 79.1% of items (wish, 100%; prognosis, 58.1%). Effective secondary prevention strategies identified as requiring improvement included: clinical report standardization, effective hospital primary care communication (telephone/mail and case managers), health-related quality of life (HRQoL) questionnaires use, and treatment compliance monitoring (prognosis agreement 33.3%, 47.8%, 18.8%, and 55.1%, respectively).
A consensus was reached by health professionals in their wish to implement strategies to optimize secondary fracture prevention; however, they considered some difficult to apply. Efforts should focus on those items with currently low application and those with greatest divergence between wish and prognosis.
建立西班牙多学科专家共识，以预防继发性骨折。
采用两轮德尔菲法共识，由科学委员会指导。43 项研究问卷由文献回顾和随后的多学科专家小组（n=12）讨论设计。第一轮问卷采用 7 分李克特量表，评估专家对现状的看法、他们希望发生的项目以及他们对项目在 5 年内实施的预测。未达成共识的项目纳入第二轮。共识定义为≥75%的同意或≥75%的不同意。共邀请来自 14 个科学协会的 102 名专家参与。
共有 75 名（应答率 73.5%）和 69 名（92.0%）专家分别回答了第一和第二轮德尔菲调查。参与者的平均年龄为 51.8 岁[标准差（SD）：10.1 岁]；24.0%为风湿病专家，21.3%为初级保健医生，14.7%为老年病专家，8.0%为内科专家，8.0%为康复医生，8.0%为妇科医生。79.1%的项目达成共识（愿望，100%；预测，58.1%）。需要改进的有效二级预防策略包括：临床报告标准化、有效医院初级保健沟通（电话/邮件和个案经理）、健康相关生活质量（HRQoL）问卷使用和治疗依从性监测（预测协议分别为 33.3%、47.8%、18.8%和 55.1%）。
卫生专业人员达成共识，希望实施优化继发性骨折预防的策略；然而，他们认为有些难以实施。应重点关注目前应用率较低且愿望与预测差异较大的项目。
