Abstract
In Alberta there are over 2,700 hip fractures per year costing the health system over $24 million in acute care costs alone. 50% of hip fracture patients have had a prior fragility fracture as a result of underlying osteoporosis (OP) that has never been assessed or appropriately treated. The Fracture Liaison Service (FLS) in Alberta aims to improve appropriate osteoporosis care, highlight and address gaps within seniors care through OP management, and provide a geriatric syndrome triage service.
The FLS has developed a linkage with the Emergency Department (ED) geriatric team whereby hip fracture patients are identified in ED using a screening tool for geriatric syndromes prior to their surgery, allowing the FLS to follow through on comorbidities likely contributing to falls. An inpatient orthopaedic unit with a dedicated Registered Nurse (RN) and a Care of the Elderly Physician see and assess hip fracture patients after surgery for appropriate osteoporosis management and treatment. Screening tools have been developed to quickly detect underlying dementia and to quantify frailty to determine life expectancy and appropriate osteoporosis therapy. Patients are also referred to Geriatric Assessment Units and fall prevention programs. Patients are then contacted in the community at 3, 6,9,12 months by the FLS RN to follow up on osteoporosis therapy, and arrange other needed tests (i.e. bone mineral density, vitamin D) as needed. Information is sent to their family physician with all results. Prior to the patient's discharge from the FLS at one year, a final hand-over letter from the program will be provided outlining the plan of care for the patient.
The FLS launched in June 2015 at the Misericordia hospital in Edmonton, Alberta (with plans to expand provincially). Currently 3 out of 4 hip fracture patients per week are being identified in the ED. Ninety-eight hip fracture patients have been identified post-surgery, with 71 patients eligible for enrollment in the program (five deceased patients). Sixty-six (50%) of those enrolled were discharged on osteoporosis medication compared to 8% prior to the program initiation. Seventeen (26%) of those were new medication starts. Of those not started, 7(11%) was patient choice. 11(31%) will be reassessed at 3 months for appropriate therapy. Nineteen (27%) of patients were referred to other inpatient or outpatient programs (i.e. falls, memory). Three month follow up calls have begun with patients for further data collection and a full 1 year qualitative and quantitative evaluation will be done.
The implementation of an FLS with dedicated personnel to proactively manage and treat patients with appropriate investigations and interventions can close the care gap that exists in OP care. It also addresses gaps in senior care and provides appropriate referral to community geriatric programs, to improve quality of life and prevent future fractures.
