Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Apr 06, 2020)
Date Submitted: Nov 5, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Telecarers in the Co-ordination of Secondary Osteoporosis Prevention in Hip Fracture Patients
ABSTRACT
Background:
There remains a significant treatment gap in osteoporosis patients. Our previous audit found that among all fragility fracture patients, rates of anti-osteoporosis medication initiation were between 10.1 to 31.5% at 1 year.
Objective:
To reduce over-utilization of hospital visits, we piloted the use of telecarers to follow up patients at specific time intervals post-discharge from hip fracture to monitor osteoporosis treatment and compliance.
Methods:
From January 2017 – January 2018, all hip fracture patients at Changi General Hospital, Singapore were automatically enrolled into the Health Management Unit (HMU) valued care hip fracture program. Upon discharge, telecarers from the HMU follow up patients to remind of attendance at clinic appointments and confirm compliance to anti-osteoporosis medication. Telecarer calls were scheduled at discharge, 3, 6 and 12 months. We assessed the acceptability, completion and treatment rates of patients enrolled in this program
Results:
537 patients with hip fracture were enrolled in the telecarer program over 1 year. 341 patients completed 12 months follow up, of which 251 patients (73.6%) were on treatment at 12 months. The most common cause of treatment rejection is patient or family rejection (34.4%), this was followed by 24.4% of physician failure to prescribe and renal impairment in 24.4%, 16.7% of patients were deemed to have advanced dementia with life limiting illness and were thus thought not suitable for treatment.
Conclusions:
Telecarer may be a useful adjunct in the monitoring of osteoporosis treatment post hip fractures. However the main limitations of treatment remain with patient and primary care clinician education which remains a challenge. Further studies should look into a combination of telecarer intervention for both patients and primary care clinicians to increase awareness of secondary fracture prevention. Given the significant mortality and morbidity post hip fractures, future efforts should also be aimed at primary prevention of hip fractures.
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