Introduction
Methods
Participants
Scientific committee
Design
Data analysis
Results
Participants
Variable | Value |
---|---|
Age [mean (SD)] | 51.8 (10.1) |
Sex [%(N)] | |
Women | 40.0% (30) |
Men | 60.0% (45) |
Scientific society* | |
SEIOMM: Spanish Society for Research on Bone and Mineral Metabolism | 57.3% (43) |
SER: Spanish Society of Rheumatology | 25.3% (19) |
SEFRAOS: Spanish Society of Osteoporotic Fractures | 17.3% (13) |
SEMERGEN: Spanish Society of Primary Health Care Physicians | 14.7% (11) |
SEMEG: Spanish Society of Geriatric Medicine | 12.0% (9) |
SEGG: Spanish Society of Geriatric Medicine and Gerontology | 10.7% (8) |
SEMG: Spanish Society of General and Family Medicine | 10.7% (8) |
AEEM: Spanish Association for the Study of Menopause | 10.7% (8) |
FHOEMO: Hispanic Foundation for Osteoporosis and Metabolic Diseases | 9.3% (7) |
SERMEF: Spanish Society of Rehabilitation and Physical Medicine | 9.3% (7) |
SEMI: Spanish Society of Internal Medicine | 8.0% (6) |
SEDISA: Spanish Society of Healthcare Executives | 6.7% (5) |
SEEN: Spanish Society of Endocrinology and Nutrition | 6.7% (5) |
Others | 9.3% (7) |
Medical specialty [%(N)] | |
Rheumatology | 24.0% (18) |
Primary care | 21.3% (16) |
Geriatrics and gerontology | 14.7% (11) |
Internal medicine | 8.0% (6) |
Physical medicine and rehabilitation | 8.0% (6) |
Obstetrics and gynecology | 8.0% (6) |
Endocrinology and nutrition | 6.7% (5) |
Orthopedic surgery and traumatology | 4.0% (3) |
Health executive | 2.7% (2) |
Others | 2.7% (2) |
Mean time of professional experience, years (SD) | 22.3 (10.9) |
Hospital type [%(N)]^ | |
Group 1: < 200 beds | 10.6% (7) |
Group 2: 200–500 beds | 31,8% (21) |
Group 3: 501–1000 beds | 25.8% (17) |
Group 4: > 1000 beds | 30.3% (20) |
Not applicable | 1.5% (1) |
Specific resources for fracture patients at the hospital [%(N)]^ | |
Fracture liaison service (FLS) | 33.3% (22) |
Others | 25.8% (16) |
Orthogeriatric unit | 13.6% (9) |
Specific osteoporosis or bone metabolism unit | 4.5% (3) |
Close cooperation with orthopedic surgery and traumatology service | 3.0% (2) |
Fracture unit | 1.5% (1) |
FLS in development | 1.5% (1) |
None | 36.7% (18) |
Not applicable | 3.0% (2) |
Current situation and consensus (wish and prognosis)
Question | Current (%)* | Wish (%) | Prognosis (%) | ||||||
---|---|---|---|---|---|---|---|---|---|
D | I | A | D | I | A | D | I | A | |
1. Specific educational campaigns are carried out for patients who have suffered a fragility fracture | 64.0 | 4.0 | 32.0 | 2.7 | 1.3 | 96.0 | 11.6 | 5.8 | 82.6 |
2. The following agents and/or groups are involved in awareness and educational campaigns regarding the prevention of fragility fractures: | |||||||||
2.1. Pharmaceutical industry 2.2. Scientific societies 2.3. Healthcare professionals 2.4. Patient advocacy groups 2.5. Media 2.6. Health managers | 6.7 13.3 38.7 30.7 37.3 72.0 | 2.7 6.7 14.7 22.7 20.0 18.7 | 90.7 80.0 46.7 46.7 42.7 9.3 | 1.3 0 1.3 4.0 6.7 6.7 | 1.3 0 1.3 5.3 2.7 1.3 | 97.3 100 97.3 90.7 90.7 92.0 | 4.0 2.7 12.0 15.9 14.5 62.3 | 0 4.0 8.0 11.6 14.5 14.5 | 96.0 93.3 80.0 72.5 71.0 23.2 |
3. There are specific health policies for the improvement of secondary prevention of fragility fractures: | |||||||||
3.1 At the national level 3.2 At the regional level | 56.0 58.7 | 12.0 9.3 | 32.0 32.0 | 1.3 4.0 | 6.7 4.0 | 92.0 92.0 | 18.8 47.8 | 15.9 8.7 | 65.2 43.5 |
4. The following strategies are applied to improve care and/or compliance in the secondary prevention of fragility fractures | |||||||||
4.1 Promotion of healthy lifestyle and fall prevention 4.2 Treatment prescription optimization 4.3. Implementation of fracture liaison services (FLS) or specific resources for fracture patients 4.4 Patient information/training 4.5 Promotion patient-physician communication 4.6 Continuous training of healthcare personnel 4.7 Promotion of social/family support | 33.3 45.3 38.7 57.3 49.3 48.0 66.7 | 17.3 17.3 12.0 12.0 18.7 9.3 16.0 | 49.3 37.3 49.3 30.7 32.0 42.7 17.3 | 2.7 2.7 4.0 2.7 1.3 5.3 2.7 | 4.0 4.0 2.7 1.3 8.0 0 6.7 | 93.3 93.3 93.3 96.0 90.7 94.7 90.7 | 5.8 7.2 5.8 5.8 11.6 11.6 31.9 | 7.2 11.6 14.5 17.4 14.5 15.9 24.6 | 87.0 81.2 79.7 76.8 73.9 72.5 43.5 |
5. The implementation of specific resources for the patient with fragility fracture (such as FLS) allows for better control and follow-up of patients and for resources savings for the health system by reducing the number of new fragility fractures. | 26.7 | 13.3 | 60.0 | 2.7 | 1.3 | 96.0 | 4.3 | 5.8 | 89.9 |
6. The different clinical practice guidelines define standardized criteria for secondary prevention of fragility fractures. | 25.3 | 4.0 | 70.7 | 0 | 2.7 | 97.3 | 4.0 | 10.7 | 85.3 |
7. To prevent a new fracture, all patients with fragility fracture receive: | |||||||||
7.1 Recommendations on healthy measures and habits 7.2 Active pharmacological treatment for osteoporosis 7.3 Recommendations on Calcium and Vitamin D Supplements 7.4 Rehabilitation and fall prevention programs | 48.0 72.0 33.3 66.7 | 16.0 6.7 17.3 9.3 | 36.0 21.3 49.3 24.0 | 2.7 2.7 4.0 2.7 | 1.3 1.3 2.7 4.0 | 96.0 96.0 93.3 93.3 | 8.7 15.9 9.3 15.9 | 5.8 5.8 13.3 14.5 | 85.5 78.3 77.3 69.6 |
8. The "treat-to-target" strategy is applied in the secondary prevention of fragility fractures | 73.3 | 14.7 | 12.0 | 10.7 | 10.7 | 78.7 | 31.9 | 14.5 | 53.6 |
9. When discussing treatment for secondary fracture prevention, the patient receives clear and concise information from the primary care physician or hospital: | |||||||||
9.1 The importance of therapeutic compliance 9.2 Fracture status and prognosis 9.3 The risk-benefit balance of the therapeutic options | 56.0 54.7 61.3 | 13.3 22.7 14.7 | 30.7 22.7 24.0 | 2.7 1.3 1.3 | 0 2.7 4.0 | 97.3 96.0 94.7 | 8.7 11.6 8.7 | 8.7 11.6 18.8 | 82.6 76.8 72.5 |
10. In routine clinical practice, a systematic control of treatment compliance is performed for the secondary prevention of fragility fractures** | 80.0 | 6.7 | 13.3 | 2.7 | 1.3 | 96.0 | 34.8 | 10.1 | 55.1 |
11. Systematic recording of fragility fractures in the patient's medical record allows better identification and secondary prevention of fragility fractures | 28.0 | 12.0 | 60.0 | 1.3 | 2.7 | 96.0 | 0 | 5.8 | 94.2 |
12. There is a registry of fragility fractures: | |||||||||
12.1 At the national level 12.2 At the regional level | 42.7 65.3 | 12.0 12.0 | 45.3 22.7 | 2.7 4.0 | 4.0 5.3 | 93.3 90.7 | 14.5 37.7 | 7.2 13.0 | 78.3 49.3 |
13. There is an efficient communication system between hospital and primary care that allows effective follow-up of the fracture patient, through | |||||||||
13.1 Shared health record 13.2 Telephone and/or specific e-mail address between assistance levels** 13.3 Case Manager (specific liaison person between primary care and hospital)** | 38.7 78.7 84.0 | 6.7 8.0 8.0 | 54.7 13.3 8.0 | 1.3 9.3 1.3 | 4.0 5.3 6.7 | 94.7 85.3 92.0 | 8.0 31.9 37.7 | 12.0 20.3 14.5 | 80.0 47.8 47.8 |
14. After a fragility fracture, the hospital doctor sends a report to the primary care doctor proposing the most appropriate specific treatment. | 65.3 | 8.0 | 26.7 | 2.7 | 2.7 | 94.7 | 8.7 | 13.0 | 78.3 |
15. The clinical reports of the fracture patient sent from hospital to primary care are standardized at the hospital level** | 86.7 | 5.3 | 8.0 | 2.7 | 4.0 | 93.3 | 52.2 | 14.5 | 33.3 |
16. There are protocols for the treatment of the patient with fragility fracture, in the case of: | |||||||||
16.1 Hip fracture (specific protocol) 16.2 Fragility fractures in general 16.3 Vertebral fracture (specific protocol) 16.4 Other fractures (specific protocols for humerus, wrist...) | 25.3 37.3 41.3 58.7 | 5.3 10.7 12.0 21.3 | 69.3 52.0 46.7 20.0 | 1.3 2.7 1.3 1.3 | 4.0 1.3 4.0 5.3 | 94.7 96.0 94.7 93.3 | 9.3 10.1 10.1 17.4 | 4.0 7.2 10.1 15.9 | 86.7 82.6 79.7 66.7 |
17. In long-term follow-up of the patient, there is an established protocol about "drug holidays" (drug treatment rest periods) of bisphosphonates and restoration of medication in treatment for secondary prevention of fragility fractures. | 54.7 | 10.7 | 34.7 | 5.3 | 2.7 | 92.0 | 13.0 | 10.1 | 76.8 |
18. In making decisions about treatment for secondary fracture prevention, the health professional considers the patient's preferences | 40.0 | 9.3 | 50.7 | 1.3 | 6.7 | 92.0 | 10.1 | 7.2 | 82.6 |
19. To promote patient involvement, there are specific tools (patient-directed informational material, in paper or on-line format) to assist decision-making on treatment for secondary prevention of fragile fractures | 52.0 | 14.7 | 33.3 | 5.3 | 6.7 | 88.0 | 5.8 | 13.0 | 81.2 |
20. In clinical practice, questionnaires are used to assess the health-related quality of life (HRQoL) of the patient with fragility fracture** | 85.3 | 5.3 | 9.3 | 6.7 | 12.0 | 81.3 | 65.2 | 15.9 | 18.8 |