Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care

Abstract

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. Purpose To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. Methods A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. Results Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. Conclusions The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Fragility Fractures and Imminent Fracture Risk in the Spanish Population: A Retrospective Observational Cohort Study

“…This is the first study to report on the incidence rate of imminent fractures after an osteoporotic sentinel fracture in Spain, with age, sex, and skeletal location of the index fractures as possible risk factors. Our results support the increased risk of imminent fracture after a recent fracture and provide key elements for early identification of risk and the application of targeted strategies aimed at preventing future fractures and mortality, such as the interventions recommended by the Fracture Liaison Services [ 36 ].…”

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

“…Finally, we found that communication between FLS units and primary care was not as fluid as it should be. Full coordination with primary care is essential to ensure the continuity of care which would improve secondary prevention of fragility fractures [ 38 ], and this should be considered to improve FLS units.…”

Evaluation of Post-Surgical Management of Fragility Fractures

“…19 Many referral services for the prevention of recurrence fractures are increasing in the world due to good results. Naranjo et al 20 propose the establishment of a framework of good practices and performance indicators to implement and monitor the coordination of fracture services and primary care in clinical practice, demonstrating the need for treatment of secondary fractures. The occurrence of previous fractures and risk factors for osteoporosis are already indicative of the need for specialized follow-up and appropriate treatment.…”