Osteoporosis International

, Volume 17, Issue 9, pp 1337–1345

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

  • S. B. Jaglal
  • C. Cameron
  • G. A. Hawker
  • J. Carroll
  • L. Jaakkimainen
  • S. M. Cadarette
  • E. R. Bogoch
  • H. Kreder
  • D. Davis
Original Article

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 

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • S. B. Jaglal
    • 1
  • C. Cameron
    • 2
  • G. A. Hawker
    • 2
  • J. Carroll
    • 3
  • L. Jaakkimainen
    • 4
  • S. M. Cadarette
    • 2
  • E. R. Bogoch
    • 5
  • H. Kreder
    • 4
  • D. Davis
    • 6
  1. 1.Department of Physical TherapyUniversity of TorontoTorontoCanada
  2. 2.Osteoporosis Research ProgramSunnybrook & Women’s College Health Sciences CentreTorontoCanada
  3. 3.Ray D. Wolfe Department of Family MedicineMount Sinai HospitalTorontoCanada
  4. 4.Sunnybrook & Women’s College Health Sciences CentreTorontoCanada
  5. 5.St. Michael’s HospitalTorontoCanada
  6. 6.Continuing Medical EducationUniversity of TorontoTorontoCanada

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