Original Article

Osteoporosis International

, Volume 17, Issue 9, pp 1337-1345

First online:

Development of an integrated-care delivery model for post-fracture care in Ontario, Canada

  • S. B. JaglalAffiliated withDepartment of Physical Therapy, University of Toronto Email author 
  • , C. CameronAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
  • , G. A. HawkerAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
  • , J. CarrollAffiliated withRay D. Wolfe Department of Family Medicine, Mount Sinai Hospital
  • , L. JaakkimainenAffiliated withSunnybrook & Women’s College Health Sciences Centre
  • , S. M. CadaretteAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
  • , E. R. BogochAffiliated withSt. Michael’s Hospital
  • , H. KrederAffiliated withSunnybrook & Women’s College Health Sciences Centre
  • , D. DavisAffiliated withContinuing Medical Education, University of Toronto

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Abstract

Introduction

The purpose of this study was to develop an integrated-care model for patients at highest risk for osteoporosis, those with a low-trauma fracture. Specific objectives were to describe the current processes and patterns of post-fracture care in hospitals in Ontario; to examine health-care professional and patient awareness of osteoporosis and the roles and responsibilities of various organizations and health care professionals; and to identify barriers and facilitators and obtain feedback on the model.

Methods

In 2002, questionnaires were completed for 178 eligible hospitals.

Results

Only 65% of hospitals inform primary-care physicians of a fracture for all patients and only 4% indicated that they provide information about osteoporosis. The main themes that emerged from the four patient focus groups (n=21) were lack of continuity of care, the absence of a link between the fracture and osteoporosis by both patients and health care providers, and need for information. Most participants agreed that something was needed to prompt their primary-care physician to investigate for osteoporosis. The four physician focus groups (n=26) identified a role for orthopaedic surgeons to flag cases.

Conclusions

From 34 key informant interviews with community-based organizations, we found a lack of integration between health care professionals who provide fracture care and those who provide osteoporosis management and fall prevention. Based on these data, we developed an integrated local-resource-based post-fracture care model, which we obtained feedback on at a stakeholder consultation workshop. The model focuses on improving emergency department/fracture clinic communication, emphasizes the need for follow-up investigation by family physicians for osteoporosis, and incorporates other health care professionals and a telemedicine multidisciplinary osteoporosis clinic. We are currently evaluating whether this model leads to an increase in appropriate investigation of and treatment for osteoporosis in patients with low-trauma fractures.

Keywords

Diagnosis Health services Low-trauma fracture Osteoporosis Treatment