Abstract
Summary
There is variation in how services to prevent second fractures after hip fracture are organised. We explored this in more detail at 11 hospitals. Results showed that there was unwarranted variation across a number of aspects of care. This information can be used to inform service delivery in the future.
Introduction
Hip fractures are usually the result of low impact falls and underlying osteoporosis. Since the risk of further fractures in osteoporotic patients can be reduced by between 20 and 70 % with bone protection therapy, the NHS is under an obligation to provide effective fracture prevention services for hip fracture patients to reduce risk of further fractures. Evidence suggests there is variation in service organisation. The objective of the study was to explore this variation in more detail by looking at the services provided in one region in England.
Methods
A questionnaire was designed which included questions around staffing, models of care and how the four components of fracture prevention (case finding, osteoporosis assessment, treatment initiation and adherence (monitoring) were undertaken. We also examined falls prevention services. Clinicians involved in the delivery of osteoporosis services at 11 hospitals in one region in England completed the questionnaire.
Results
The service overview showed significant variation in service organisation across all aspects of care examined. All sites provided some form of case finding and assessment. However, interesting differences arose when we examined how these components were structured. Eight sites generally initiated treatment in an inpatient setting, two in outpatients and one in primary care. Monitoring was undertaken by secondary care at seven sites and the remainder conducted by GPs.
Conclusions
The variability in service provision was not explained by local variations in care need. Further work is now needed to establish how the variability in service provision affects key patient, clinical and health economic outcomes.
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Acknowledgments
This project was funded by the NIHR Health Services and Delivery Research programme (project number 11/1023/01). Support was received from the Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS or the Department of Health.
The REFReSH study group consists of Dr Andrew David Judge, Dr Muhammad Kassim Javaid, Professor Nigel Arden, Professor Cyrus Cooper, Professor Andrew Farmer, Dr Daniel Prieto-Alhambra, Dr Jose Leal, Professor Michael Goldacre, Professor Alastair Gray, Dr Janet Lippett, Dr Rachael Gooberman-Hill and Laura Graham.
We would like to acknowledge Buckinghamshire Healthcare NHS Trust, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, University Hospitals Southampton NHS Foundation Trust, Royal Berkshire NHS Foundation Trust and Hampshire Hospitals NHS Foundation Trust for their participation in the study. We would also like to thank the other trusts which participated.
The evaluation was undertaken in close collaboration with the IOF Capture the Fracture initiative, and we are most grateful to Dr Carey Kyer, Professor Kristina Akesson, and Mr Paul Mitchell, all of whom have made considerable input to this initiative. We would also like to thank all the members of the FRiSCy group for contributing their time and expertise to this study.
Ethical approval
Approval of this work by an ethics committee was not required. This study was registered as a service evaluation with the relevant NHS Trusts.
Conflicts of interest
A. Judge has held advisory board positions (which involved receipt of fees) for Anthera Pharmaceuticals and Servier and received consortium research grants from ROCHE. M.K. Javaid has received in the last 5 years honoraria for travel expenses, speaker fees and/or advisory committees from Lilly UK, Amgen, Servier, Merck, Medtronic, Internis and Consilient Health. He also serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation. C. Cooper has received consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche. S. Drew, S. Sheard and J. Chana have no disclosures.
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Drew, S., Sheard, S., Chana, J. et al. Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England. Osteoporos Int 25, 2427–2433 (2014). https://doi.org/10.1007/s00198-014-2775-5
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DOI: https://doi.org/10.1007/s00198-014-2775-5