During their lifetime, approximately 50% of Canadian women and 30% of Canadian men will experience at least one fracture due to bone fragility (FF). Evidence is growing regarding prevention programs' effectiveness to prevent falls, but prevention of fractures through fall prevention programs has enjoyed limited success. Falls prevention programs and post-fracture screening programs leading to pharmacological treatment are very different strategies, with a shared ultimate goal. Coordination between those who repair fractures and those who manage the patient to prevent the next fracture is critical. The overarching aim of this proposal is to generate evidence-based knowledge about the effectiveness and cost-effectiveness of an integrated FF prevention program, as well as a portrait of the barriers and facilitating factors for such programs. More specifically, the objectives are: 1) to combine existing fall prevention and post-fracture management programs in the province of Quebec into integrated FF prevention programs; 2) to compare the performance of these integrated programs to control sites, using a pragmatic study design; 3) to identify barriers as well as factors that improve effectiveness across different implementation milieu; and 4) to develop and engage in active knowledge transfer activities in Quebec regions where integrated FF prevention programs are neither adequately nor successfully implemented. Drawing upon the literature on integrated healthcare, fall and fracture prevention, we hypothesize that an integrated FF program can reduce the risk of a subsequent fracture by at least 30% in the population of interest. The proposed team is poised to develop new interdisciplinary collaborations among healthcare practitioners and decision makers involved in the prevention of FFs. The program is built upon existing healthcare and structures and programs and in turn, will truly measure the effectiveness of an integrated FF prevention program. The results will ultimately lead to improvements in the existing knowledge base, address policy-relevant and health systems problems, and assist in the design and implementation of FFs prevention programs.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
631
Each participant's primary care physician will receive written information containing a presumed osteoporosis diagnosis, investigations to be performed, correct interpretation of any bone densitometry results in the context of a fragility fracture, and treatment options. The study coordinator will be responsible for orienting the participant to an appropriate local fall prevention program.
Centre hospitalier Hôtel-Dieu d'Amos
Amos, Quebec, Canada
CSSS du Roché Percé (Centre hospitalier de Chandler)
Chandler, Quebec, Canada
Hôpital de Hull
Gatineau, Quebec, Canada
Hôpital Charles Lemoyne
Greenfield Park, Quebec, Canada
Hôpital Maisonneuve-Rosemont
Montreal, Quebec, Canada
Hôpital Jean-Talon
Montreal, Quebec, Canada
Hôpital Sacré-Coeur de Montréal
Montreal, Quebec, Canada
Centre hospitalier régional de Lanaudière
Saint-Charles-Borromée, Quebec, Canada
CSSS de St-Jérôme (Hôpital régional de St-Jérôme)
Saint-Jérôme, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke
Sherbrooke, Quebec, Canada
Incidence of secondary fragility fracture
Time frame: 18 months post recruitment
Initiation of osteoporosis treatment by the primary care physician
Osteoporosis treatment includes bisphosphonates or other effective osteoporosis drugs.
Time frame: At 6, 12, 18, and 60 months post recruitment
Compliance with osteoporosis treatment.
The data collected from the participant will be validated with the participant's pharmacist through the medication possession ratio. The medication possession ratio is measured from the first to the last prescription, with the denominator being the duration from index to the exhaustion of the last prescription and the numerator being the days supplied over that period from first to last prescription and the numerator being the total number of days in the interval.
Time frame: At 6, 12, 18, and 60 months post recruitment
Time to first fall event
Time frame: Within the first 18 months post recruitment
Incidence of secondary fragility fractures.
Time frame: At 24, 36, 48 and 60 months post recruitment
Number of clinically significant fall events.
Time frame: At 18, 24, 36, 48 and 60 months post recruitment
Fall-related hospitalizations
Fall-related hospitalizations will be recorded in the participant diary and at each telephone follow-up, and validated with the participant's hospital records.
Time frame: At 18, 24, 36, 48 and 60 months post recruitment
Fragility fracture-related death
Fragility fracture-related death will be confirmed from a provincial administrative database (Regie de l'assurance maladie du Quebec - RAMQ).
Time frame: At 18, 24, 36, 48 and 60 months post recruitment
Participants' quality of life
Euro-QOL
Time frame: At 18, 24, 36, 48 and 60 months post recruitment
Practice of physical activities
CHAMPS
Time frame: At 6, 12, 18, 24, 36, 48 and 60 months post recruitment
Fragility fracture-related costs
Medical costs from the participant's hospital record include: medical assessment, prescription and non-prescription drugs; and resource use related to the management of the fragility fracture and/or long-term complications, including hospitalization. As well, lost days of work, annual income (if the participant is in the labour force), travel to the hospital and/or rehabilitation facilities, parking, and out-of-pocket expenses for drugs and rehabilitation devices (e.g. splint) will be compiled. Protocol-driven costs will be excluded, with the exception of the costs related to the participants' fall prevention program.
Time frame: At 18 and 60 months post recruitment
Admission to a long-term care facility
Time frame: At 18, 24, 36, 48 and 60 months post recruitment
Participants' perceptions of care integration
All participants' perceptions of care integration will be captured 12 months after the beginning of the intervention period, or following an early withdrawal from the study.
Time frame: At 12 months post intervention
Intervention participant's satisfaction with the fragility fracture prevention program
Time frame: At 12 months post intervention
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