Dedicated coordinators improve osteoporosis care for patients in smaller communities

Having a dedicated osteoporosis coordinator may help individuals with low bone density pursue the medical attention and preventive care they need following a low-impact fracture.

That is the thrust of a new study conducted by a team of Canadian healthcare specialists and published in the journal Osteoporosis International. The group found that having a centralized coordinator who explained and followed up on osteoporosis-related care dramatically improved the odds that a participant would proactively pursue post-fracture treatment.

This sort of one-on-one oversight can be critical for osteoporosis management, especially in small communities that otherwise have few clinical coordination resources.



For the study, scientists initiated a randomized trial of centralized coordination in 36 small-town hospitals throughout the province of Ontario.



In all, 267 adults over the age of 40 were enrolled in the investigation. Participants qualified for the study if they were admitted to a hospital for a low-impact fracture or fragility-related bone injury. In general, most volunteers were women in their 60s.

The intervention itself consisted of having patients meet once a month with a healthcare coordinator. In this study, that position was held by a licensed physical therapist who held a "centralized" post, meaning he or she she held conferences with patients either in person or via teleconference on the Ontario Telemedicine Network.

Researchers found that in the six months following fractures, patients who had access to such a professional were more likely to receive proper osteoporosis care than those given typical management options.

Specifically, 45 percent of those who saw the coordinator ended up getting the necessary bone healthcare, while only 26 percent of the control group sought such care without a coordinator's help.

The intervention also made individuals more likely to get a bone scan following a fracture. In the six months after such injuries occurred, 51 percent of patients who talked to a coordinator ended up pursuing a bone mass density (BMD) scan. By contrast, just 21 percent of the control group opted for similar tests in that time period.

Researchers concluded that regular, dedicated, one-on-one case management may help people with fractures get the bone health tests they need, even if a coordinator communicates with patients primarily through teleconferencing.

The group emphasized that these results may be more pronounced in small communities.

This study is by no means the first to come to such a conclusion. Another study published in the same journal found that having a nursing case manager increased a patient's odds of getting a BMD test by nearly 30 percent.

Even more dramatically, the report indicated that such a coordinator almost quadrupled the likelihood that osteoporotic participants would start taking bisphosphonates shortly after suffering a wrist fracture, compared to patients given phone-, fax- and pamphlet-based reminders.

Another investigation appearing in the the Journal of Bone and Joint Surgery added that such a coordinator is likely to prevent at least three hip fractures per every 500 osteoporosis patients, saving a hospital at least $51,000 in care costs.
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