Abstract
Purpose
To describe the implication of Family Physicians (FPs) in the management of osteoporosis revealed by a fragility fracture.
Method
The impact and costs of fractures is straining the health system. A better collaboration between specialists and FPs should improve the evaluation and treatment of affected patients. Since January 2007, the OPTIMUS initiative is an attempt to reach that objective in the Estrie area of the Province of Quc. With OPTIMUS, rates of appropriate treatment of osteoporosis at one year in previously untreated patients more than double (53% vs 20%). In OPTIMUS, FPs remain responsible for investigation and treatment of their patients after identification of a bone fragility fracture. A coordinator based in orthopaedists outpatient clinics identifies fragility fractures in patients older than 50 y.o., informs them about bone fragility and its link to osteoporosis, and spurs them to contact their FPs to get treated; the importance of persistence on treatment is reinforced during phone follow ups. Initially and when patients remain untreated upon follow up, the coordinator sends a letter to the patients FP about the occurrence of the fracture, its predictive value for future fractures, and the need for investigation and treatment. This represents a personalized form of continuous medical education for FPs, in the hope that FPs become leaders in the prevention of fragility fractures. To evaluate the perception of FPs about OPTIMUS, we performed a mail survey targeting FPs reached at least once by OPTIMUS.
Results
The survey was sent to a total of 212 FPs. One hundred and nine (51.4%) answered. Of these, 97 (89%) agreed that a fragility fracture is an indication for treatment of osteoporosis; 56 (51%) agreed that OPTIMUS had helped them take charge of osteoporosis; and 105 (96.3%) were Satisfied or Very Satisfied of the OPTIMUS initiative.
Conclusion
Because of this high level of acceptance, we propose to put into place a more elaborate intervention including a fall prevention program that will be managed by nurse coordinators in 16 FP Groups (GMF); these 16 Groups include 178 of the 360 FPs of the area. The FPs practicing in GMF are also involved in teaching to colleagues, residents and medical students; we expect an exponential effect on the practice of FPs over the years. We believe this enhanced intervention will improve the quality of life and autonomy of the patients while decreasing their rate of fractures.
