Introduction: The incidence and cost of fragility fractures (FF) is predicted to increase nationally (McGowan et al. 2013). Hip fractures are one of the most common FF, half of whom have previously sustained a previous FF. Targeted multidisciplinary (MDT) secondary prevention advice to all FF patients is recommended by international guidelines to reduce the risk of future FFs (British Orthopaedic Association, 2007). Low rates of secondary prevention education (< 20%) have been demonstrated for FF patients attending outpatient physiotherapy (PT) and occupational therapy (OT) in a large academic teaching hospital with a tertiary orthopaedic centre in Dublin.
The aim of this quality improvement initiative was to:
1. Establish a novel MDT BH information class to improve FF patient access to secondary prevention bone health (BH) education.
2. Evaluate FF patient knowledge regarding BH before class attendance
3. Explore patient experience of a multidisciplinary (MDT) BH information class.
Methods: A new MDT BH education class was developed by staff from the departments of physiotherapy (PT), nursing, occupational therapy (OT) and nutrition & dietetics. FF outpatients > 50 years attending PT, OT or the osteoporosis nurse were invited to attend by their treating therapist. Patients with cognitive impairment were excluded. The interactive monthly one-hour class provides evidence-based information regarding fracture prevention, diet, exercise, falls prevention, balance and local/online BH resources. Outcomes collected included osteoporosis knowledge questionnaire pre-class (n=93) and service-user experience questionnaire 6 weeks post class (n=26). Data were analysed with SPSS using descriptive statistics, and is ongoing prospectively.
Results: 102 patients attended between April 2016 and Feb 2017. Initial analysis of pre-class BH knowledge questionnaires indicated in-correct answers for questions regarding calcium intake (86.3% (n=79)), physical activity (41.7% (n=37)) and menopause (16% (n=13)). Post class evaluation demonstrated that the class was an excellent or very good (81%, n=21) patient experience. Eighty-eight percent (n=23) of patients reported receiving sufficient BH information during the class. High patient confidence was reported regarding BH lifestyle changes for diet (77%, n=20), physical activity (73%, n=19) and falls prevention (65%, n=17).
Conclusion:This new MDT BH information class was successfully implemented and was feasible. Initial analysis indicates a low level of BH knowledge in this FF outpatient population. The class enables FF outpatients to access secondary prevention BH information. This new initiative is a positive patient experience resulting in high patient confidence for making positive BH lifestyle changes to prevent further FFs. This model of BH education will continue and may be expanded to target specific patient sub-groups at risk of FFs e.g. COPD and renal disease patients.
References:
McGowan, B. Casey, M. C. Silke, C. Whelan, B. Bennett, K. Hospitalisations for fracture and associated costs between 2000 and 2009 in Ireland: a trend analysis (2013). Osteoporosis International, 24(3); pp 849–857
British Orthopaedic Association (2007) The Care of Patients with Fragility Fracture. Available from: http://www.fractures.com/pdf/BOA-BGS_Blue_Book.pdf
(Accessed 03 November 2015)
Ethics:Not required for AMNCH/SJH Ethics Committee for clinical audit of quality improvement initiatives.
