The importance of communication in secondary fragility fracture treatment and prevention
We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians.
Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians.
The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible.
Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.
KeywordsCommunication Continuity of care Early intervention Osteoporosis Secondary fragility fractures Women’s health
- 2.Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(Suppl 10):S1–34Google Scholar
- 30.Yin RK (2003) Applications of Case Study Research, 2nd edn. Sage Publications, Thousand Oaks, CAGoogle Scholar
- 31.Agar MH (1986) Speaking of Ethnography. Sage Publications, Newbury Park, CAGoogle Scholar
- 32.Creswell JW (1998) Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Sage Publications, Thousand Oaks, CAGoogle Scholar
- 34.Strauss A, Corbin J (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications, Newbury Park, CAGoogle Scholar
- 35.Jennett PA (1995) Chart stimulated recall: a technique to assess clinical competence and performance. Educ Gen Practice 6:30–34Google Scholar
- 36.Borkan JM (1999) Immersion / crystallization. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 179–194Google Scholar
- 37.Denzin NK (1989) Interpretive Interactionism. Sage Publications, Newbury Park, CAGoogle Scholar
- 38.Crabtree BF, Miller WL (1999) The dance of interpretation. In: BF Crabtree, WL Miller (eds) Doing Qualitative Research. Sage Publications, Thousand Oaks, CA, pp 127–144Google Scholar
- 39.Meadows LM, Morse JM (2001) Constructing evidence within the qualitative project. In: JM Morse, JM Swanson, A Kuzel (eds) The Nature of Qualitative Evidence. Sage Publications, Thousand Oaks, CA, pp 187–200Google Scholar
- 40.Einhorn T (2000) Osteoporosis: the missed opportunity of orthopaedics [commentary]. J Bone Joint Surg, Available at http://www.jbjs.org/Comments/c_p_einhorn.shtml. Accessed 16 August 2006