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Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial

Abstract

Summary

We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program.

Introduction

Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care.

Methods

Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months.

Results

At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58–3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14–3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61–0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41–3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40–3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription.

Conclusion

A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.

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Acknowledgements

We would like to thank D. Foesser for the great work she performed by contacting all women by telephone; the physicians, orthopedic surgeons, and staff of the emergency and orthopedics departments from the 20 hospitals involved in patients recruitment: Dr. X. Jacob, Centre Hospitalier Universitaire Lyon-Sud, HCl, 69310 Pierre-Bénite; Dr. F. Boissier, Centre Hospitalier Pierre Oudot, 38317 Bourgoin-Jallieu; Dr. R. Brunon, Centre Hospitalier, 42700 Firminy; Dr. Hage and Ms. C. Dumas, Centre Hospitalier, 69655 Villefranche sur Saône; Drs. V. Locquet, F. Breden, M. Ninou, P. Rostoucher, L. Erhard, K. Elkholti, M. Pozetto, Institut Chirurgical de la Main et du Membre supérieur, Clinique du Tonkin, 69100 Villeurbanne; Dr. H. Rouvière, Clinique Charcot, 69110 Ste.-Foy-les-Lyon; Dr. J.J. Azoulay, Clinique du Parc, 42276 Saint-Priest en Jarez; Dr. W. Tohoubi, Centre Hospitalier, 42300 Roanne; Dr. H. Kaddour, Centre Hospitalier Universitaire Grenoble Nord, 38043 Grenoble; Dr. A. Rakaa, Clinique mutualiste ‘Les Portes du Sud’, 69694 Vénissieux; Pr. G. Herzberg, Centre Hospitalier Universitaire Edouard Herriot, HCL, 69437 Lyon; Dr. P. Ganansia, Centre Hospitalier, 38506 Voiron; Dr. O. Carle, Centre Hospitalier, 07100 Annonay; Dr. M. Prost, Fondation Hotel-Dieu, 71206 le Creusot; Dr. S. Tabyaoui and Ms. P. Sultan, Centre Hospitalier, 71307 Montceau les Mines; Dr. J. Asdrubal, Centre Hospitalier, 71018 Mâcon; Dr. J. Henner, Centre Hospitalier, 73200 Albertville-Moutiers; Dr. J. Lopez, Centre Hospitalier Privé de la Loire 42100 St-Etienne; Drs. A. Alnachif, P.E. Koueke, Centre Hospitalier Emile Roux, 43012 Le Puy en Velay; Drs. A. Henniche, F. Champly, Centre Hospitalier, 74703 Sallanches; Dr. C. Dupraz from ‘the Collège Lyonnais des Généralistes Enseignants’.

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Correspondence to B. Merle.

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Funding

Grant from the French Ministry of Health: PREVOST, PREPS 2012- n°: 12-027-0088

Conflicts of interest

None.

Additional information

Trial Registration—clinicaltrials.gov Identifier n°: NCT01780012

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Merle, B., Chapurlat, R., Vignot, E. et al. Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Osteoporos Int 28, 1549–1558 (2017). https://doi.org/10.1007/s00198-017-3953-z

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  • DOI: https://doi.org/10.1007/s00198-017-3953-z

Keywords

  • Osteoporosis
  • Osteoporotic fractures
  • Patient empowerment
  • Randomized controlled trial
  • Secondary prevention