Preventing injury by attending to the injured

I came across a paper summarising the efforts of an osteoporotic fracture liaison service over the period of one year (July 2008-June 2009) which I thought may be of interest to readers of the Injury Prevention blog.

Now at first glance this may seem more like injury treatment, rather than injury prevention, however as Vaile, Sullivan, Connor, and Bleasel note,  “patients sustaining a first fracture are known to be at higher risk of sustaining future fracture“. Therefore, in addition to the noteworthy costs not only in terms of healthcare but also morbidity and mortality, treatment of at-risk patients (i.e., those have already sustained a fracture) has considerable implications for injury prevention efforts, particularly as many societies experience an ageing population.

From 768 eligible patients (aged over 50 with low trauma fracture) attending a major Australian metropolitan hospital and associated small local hospital, 570 patients attended the fracture clinic. Of these, 263 patients were deemed to not require additional treatment and fracture clinic was offered to 180 patients with a 90% participation rate. Treatment included vitamin D and calcium supplementation, bisphosphonate therapy, and for a small proportion strontium ranelate.

Of course, intervention efforts are not without difficulties, and pleasingly the Authors discuss at length some of the problems they experienced, including

* changes in coding patient histories, requiring review of every emergency department daily discharge diagnosis (approximately 1000 discharges per week) which was very time-consuming and therefore contributed to errors of inclusion and exclusion when identifying eligible patients;

* tracking eligible patients who did not attend the fracture clinic was very time-consuming;

* staffing issues including absence and time constraints which was further compounded by substantially increased staff workload; and

* no funding for ongoing secretarial or information technology support, meaning nursing staff undertake clerical support.

Notwithstanding these difficulties, the fracture liaison service enabled access to osteoporotic assessment to most low trauma fracture patients who were at risk of further fracture.





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