Closing the Post Fracture Care Gap in Manitoba
- Conditions
- Osteoporosis
- Interventions
- Other: Information letters
- Registration Number
- NCT00594789
- Lead Sponsor
- University of Manitoba
- Brief Summary
The objective of this study is to evaluate a post-fracture intervention for improving osteoporosis care in older men and women who have suffered a fracture that may indicate the presence of osteoporosis. Although osteoporosis can be identified with a bone mineral density (BMD) test, most individuals with osteoporosis are not diagnosed until they fracture. Post-fracture care often "falls between the cracks" when there is a breakdown in communication between hospital and community, or between specialists and primary care physicians. Often physicians and patients fail to make the connection between an acute fracture and osteoporosis, or the value of secondary prevention strategies. If untreated, there is an extremely high rate of additional fractures after a first osteoporotic fracture. It follows that improving BMD testing and/or treatment in appropriately identified individuals is a necessary step in optimizing post-fracture patient care. Over the next three years we will be testing and optimizing a notification procedure to physicians and/or patients relying upon fracture events reported to the provincial health service (Manitoba Health).
- Detailed Description
A major 'care gap' exists in the management of patients with fractures suggestive of osteoporosis. Currently, only a small minority of these individuals who are at high risk for recurrent fractures undergo evaluation for possible treatment. We propose to test and optimize a novel approach to address this question, relying upon fracture events reported to provincial health service (Manitoba Health) as a mechanism for osteoporosis case identification and enhancing post fracture care.
Phase 1 (one year duration): individuals meeting the fracture case definition will be randomized to usual care (no intervention), physician notification and physician/patient notification. The notification will provide a general recommendation for osteoporosis assessment. The use of appropriate post-fracture investigations and treatment will be prospectively evaluated.
Phase 2 (up to two years duration): the intervention will be refined and iteratively trialed for all individuals meeting the fracture case definition.
Phase 3: a recommendation for long term maintenance of the post-fracture intervention will be developed.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 4264
-
Women and men age 50 and older with one of the following fracture definitions:
- Hip fracture (physician ICD-9-CM 820-821 plus a procedure code for site-specific fracture reduction or fixation, open or closed)
- Spine fracture (physician ICD-9-CM code 805), or
- Humerus fracture (physician ICD-9-CM code 812), or
- Colles' fracture (physician ICD-9-CM code 813 plus a physician claim for site-specific fracture reduction or fixation, open or closed, or cast application).
- Age less than 50.
- Non-Manitoba residents, cancelled Manitoba Health coverage, death or discharge to a personal care home.
- A fracture event in the previous 12 months meeting the study case definition (i.e., only a single notification per year is planned).
- Hip or wrist fractures without a procedure tariff.
- Current treatment with an osteoporosis medication.
- BMD testing within the preceding 3 years.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 1 (physician-only) Information letters Physician(s) connected with a fracture that meets study inclusion criteria. 2 (physician/patient) Information letters Physician(s) and patient connected with a fracture that meets study inclusion criteria.
- Primary Outcome Measures
Name Time Method Rates of BMD testing and/or osteoporosis pharmacotherapy in the year post-fracture using the population-based provincial administrative health data repository. 3 years (Phase 1 analysis at 1 year)
- Secondary Outcome Measures
Name Time Method An evaluation of post-fracture BMD testing and treatment rates in the years prior to the Phase 1 will also be performed to document practice patterns before the intervention. 1 year For individuals referred for BMD testing, an evaluation of treatment appropriateness will be performed based upon BMD results and 10-year fracture risk methods. 3 years (Phase 1 analysis at 1 year) Repeat fracture rates will be also studied as a secondary endpoint. 3 years (Phase 1 analysis at 1 year)
Trial Locations
- Locations (1)
St. Boniface General Hospital
🇨🇦Winnipeg, Manitoba, Canada