Osteoporosis re-fracture prevention – patient and clinicians
Professor Lyn March, Staff Specialist and Head of Rheumatology Department: The Leading Better Value Care program is just incredible. We have a wonderful program called the Osteoporosis Refracture Prevention program or ORP. The journey has been, maybe even 20 years getting here, and for decades we knew the evidence - if you've had one fracture, you're at very high risk of another fracture.
Through the Agency for Clinical Innovation and the Musculoskeletal Network, we set about trying to develop the model of care, implement them, to evaluate them and show that services like the ORP can really make a difference. We identified through a lot of evaluation that we needed a coordinated approach. We needed a data system to find the patients, triaging that list to identify that they're the right people to invite in and then the most important part of that whole service is our fraction liaison coordinator. It just cannot be done without a knowledgeable person or persons as the program gets larger.
Lillias Nairn, Fracture Liaison Coordinator: Well, we've been very fortunate at Royal North Shore to have an electronic and screening tool that helps us to identify patients who come through the hospital. It will identify people who've come in through the emergency department with a fracture, perhaps who've been in the hospital and sustained a fracture while they're in hospital, but I guess very importantly there's a number of investigative procedures that help us to identify those incidental vertebral compression fractures. If you're trying to prevent future fractures it is best to pick patients up as early as possible, so that they can get started on treatment to slow down their bone loss, which is what osteoporosis is, because in that way, we can minimise the chance of them having another fracture.
Professor Lyn March, Staff Specialist and Head of Rheumatology Department: Osteoporosis is one of those conditions, you don't know you have it until you actually have the fracture, that's why it's so important to identify that first fracture and try to stop the next one.
Marcelle McCrystal, Patient: When I saw Lillias, she was terrific because she kind of, we talked about diet, we talked about exercise, we talked about lifestyle and that kind of made me stop and think that it was time to do something. So that was good and I've been semi good since, but exercise is probably the area that I haven't followed up on as much as I should have and it's giving me where I need to go now, as a preventative rather than a treatment procedure which is really good. Things are going pretty well.
Professor Lyn March, Staff Specialist and Head of Rheumatology Department: 30% of the people who come with a hip fracture, they've had another fracture before and if we'd got in earlier, they really wouldn't have that terrible hip fracture, so that's why we called it the refracture prevention program so we say we're going to stop that next factor, we're going to free up the bed days. Other people who need those beds get into them, so the service just operates better.
Lillias Nairn, Fracture Liaison Coordinator: Collecting the patient reported outcomes measures has been a requirement of this service. They keep us accountable to the patient. Overall, we have a very very high satisfaction rating and among our patients, but there's always the need for us to look for how we can improve. You know, we're not perfect, we're human, we work very hard, we try our best. Sometimes the patients don't actually feel that that's good enough and we have to listen.
Marcelle McCrystal, Patient: Today's been really reassuring because what it's really kind of indicated that the treatments going well, catching it early in my case has been good.