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

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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.

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Acknowledgements

This project was supported by a grant from the Ontario Women’s Health Council. Dr. Jaglal is the Toronto Rehabilitation Institute/University of Toronto Chair in Rehabilitation Research. Dr. Hawker is a Canadian Institutes of Health Research Scientist and FM Hill Chair in Academic Women’s Medicine at the University of Toronto. Dr. Kreder is the Chair in Orthopaedic Clinical Epidemiology at Sunnybrook and Women’s College Health Sciences Centre. Dr. Carroll is the Sydney G. Frankfort Chair in Family Medicine at the University of Toronto and Ms. Cadarette is an Ontario Ministry of Health and Long-Term Care/CIHR Doctoral Fellow and an Ontario Women’s Health Scholar.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada

    S. B. Jaglal

  2. Osteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre, Women’s College Site, 76 Grenville St., 8th floor, Toronto, ON, M5S 1B2, Canada

    C. Cameron, G. A. Hawker & S. M. Cadarette

  3. Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, 600 University Ave., Suite 413, Toronto, ON, M5G 1X5, Canada

    J. Carroll

  4. Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Ave., Room G1-39, Toronto, ON, M4N 3M5, Canada

    L. Jaakkimainen & H. Kreder

  5. St. Michael’s Hospital, 55 Queen St. East, Suite 800, Toronto, ON, M5C 1R6, Canada

    E. R. Bogoch

  6. Continuing Medical Education, University of Toronto, 500 University Ave. Suite 650, Toronto, ON, M5G 1V7, Canada

    D. Davis

Authors
  1. S. B. Jaglal
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  2. C. Cameron
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  3. G. A. Hawker
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  4. J. Carroll
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  5. L. Jaakkimainen
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  6. S. M. Cadarette
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  7. E. R. Bogoch
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  8. H. Kreder
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  9. D. Davis
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Corresponding author

Correspondence to S. B. Jaglal.

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Jaglal, S.B., Cameron, C., Hawker, G.A. et al. Development of an integrated-care delivery model for post-fracture care in Ontario, Canada. Osteoporos Int 17, 1337–1345 (2006). https://doi.org/10.1007/s00198-006-0076-3

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  • DOI: https://doi.org/10.1007/s00198-006-0076-3

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