University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2024 Jun;39(8):1407-1413. doi: 10.1007/s11606-023-08568-8. Epub 2023 Dec 15.
The Fracture Liaison Service (FLS) care model, a care coordination program for patients experiencing a fragility fracture, is proven to improve management of patients with an osteoporotic fracture, but treatment initiation gaps persist.
We describe the evolution of a centralized FLS within a university-based healthcare system, including impact of adding clinical pharmacist consultation, and describe circumstances surrounding continued care gaps.
Cohort analysis of osteoporosis medication initiation before FLS, after initial implementation, and after addition of pharmacist consultation.
Individuals aged 65 and older experiencing any fragility fracture between 7/1/16 and 3/31/22.
A centralized team outreached eligible patients, ordered dual x-ray absorptiometry and laboratory tests as needed, and scheduled an osteoporosis-focused primary care appointment. Three years after FLS implementation, clinical pharmacist consultative review was added prior to the primary care visit.
Initiation of osteoporosis pharmacologic therapy, completion of DXA, primary care follow-up rate, and description of circumstances where therapy was not initiated.
Of 1204 new fractures between 7/1/16 and 3/31/22, 315 patients were enrolled in one of two FLS phases, and 89 eligible historical controls were identified. Medication initiation rates went from 22/89 (25%) pre-FLS to 201/428 (47%) after-FLS phase 1 [POST1] (p<0.001) and to 106/187 (57%) after FLS phase 2 (POST2), when clinical pharmacist consultation was added (p=0.03 versus POST1). DXA was completed in 56/89 (67%) of pre-FLS patients, 364/428 (85%) POST1 patients (p<0.001 versus pre), and 163/187 (87%) POST2 (p< 0.001 versus PRE, p=0.59 versus POST1). Of 375 patients who did not initiate osteoporosis medication, more in the combined post-FLS cohorts attended a follow-up primary care appointment (233/308, 76% attended, versus pre-FLS 41/67, 61%, p=0.016).
An FLS including centralized outreach and care coordination significantly improved patient follow-up, DXA, and medication initiation. Addition of de-centralized pharmacist consultation further improved medication initiation rates.
骨折联络服务（FLS）护理模式是一种针对脆性骨折患者的护理协调计划，已被证明可改善骨质疏松性骨折患者的管理，但治疗启动仍存在差距。
我们描述了一个大学附属医院系统内集中式 FLS 的演变，包括添加临床药师咨询的影响，并描述了持续护理差距的情况。
骨质疏松症药物治疗开始前、初始实施后和添加药师咨询后的队列分析。
2016 年 7 月 1 日至 2022 年 3 月 31 日期间，年龄在 65 岁及以上，经历任何脆性骨折。
一个集中的团队联系符合条件的患者，根据需要安排双能 X 线吸收法和实验室检查，并安排骨质疏松症为主的初级保健预约。在 FLS 实施三年后，在初级保健就诊前增加了临床药师咨询审查。
骨质疏松症药物治疗的启动、DXA 的完成、初级保健随访率，以及未启动治疗的情况描述。
在 2016 年 7 月 1 日至 2022 年 3 月 31 日期间的 1204 例新骨折中，有 315 例患者参加了 FLS 的两个阶段之一，有 89 例符合条件的历史对照。药物治疗启动率从 FLS 前的 89/22（25%）增加到 FLS 第一阶段后的 428/201（47%）[POST1]（p<0.001），再增加到 FLS 第二阶段后的 187/106（57%），当添加临床药师咨询时[POST2]（p=0.03 与 POST1 相比）。在 FLS 前的 89 例患者中，有 56/89（67%）完成了 DXA，POST1 患者中有 364/428（85%）（p<0.001 与 FLS 前相比），POST2 患者中有 163/187（87%）（p<0.001 与 FLS 前相比，p=0.59 与 POST1 相比）。在未启动骨质疏松症药物治疗的 375 名患者中，更多的联合 FLS 后患者参加了随访初级保健预约（308/233，76%参加，与 FLS 前的 67/41，61%相比，p=0.016）。
包括集中外联和护理协调的 FLS 显著改善了患者的随访、DXA 和药物治疗的启动。添加分散的药师咨询进一步提高了药物治疗的启动率。
