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SAT0367 Management of fragility fractures: Impact of the optimus initiative on family physicians
  1. M.-C. Beaulieu1,
  2. F. Cabana2,
  3. M. Beaulieu3,
  4. S. Roux4,
  5. G. Boire4
  1. 1Dept. of Family Medicine
  2. 2Division of Orthopaedics, Université de Sherbrooke, Sherbrooke
  3. 3Health Services Program, Merck Canada Inc., Montréal
  4. 4Division of Rheumatology, Université de Sherbrooke, Sherbrooke, Canada

Abstract

Background To attenuate the osteoporosis (OP) care gap, the OPTIMUS initiative (Osteoporosis and Peripheral fractures: Treatment and Investigation in Multidisciplinary care at the CHUS) was first implemented in the Sherbrooke area in January 2007, to inform and empower the Family Physicians (FPs) to diagnose and treat OP revealed by a Fragility Fracture (FF) in one of their patients. In this prospective initiative, women and men over age 50 were screened for incident FF in orthopaedic clinics, and eligible outpatients were randomized to Standard Care (SC) or to either Minimal (MIN) or Intensive (INT) interventions, consisting in initial face-to-face and phone follow-up interventions with patients and notification letters containing individualized recommendations to FPs. As of December 2010, 1043 outpatients (including 200 SC controls) with nonvertebral FF and 250 hip FF inpatients have been included. More than 270 of the 360 FPs from the Sherbrooke area of the Province of Quebec have been reached at least once by OPTIMUS. A better collaboration between bone health specialists, orthopaedists and FPs has taken place and treatment initiation has been improving. Initiation rates and persistence on treatment at one year after a FF event have increased from less than 20% in the control group to 43% in the MIN and 55% in the INT Intervention groups.

Objectives To determine the factors that have influenced FPs’ decision to treat OP

Methods 272 FPs reached by OPTIMUS were sent a questionnaire evaluating their main reasons to start a treatment for osteoporosis, their knowledge and use of fracture risk calculators, and the potential for collaboration with nurses from Family Physician Groups (GMF), a Ministry of Health-supported grouping of FPs. One hundred and three (38%) filled questionnaires were returned.

Results Previous FFs (100/103; 97%) and BMD results (80/103; 78%) were the two major indicators (Agree and Strongly Agree) mentioned by FPs to initiate treatment of osteoporosis; 10-year fracture risk (67/103; 65%) was less frequently mentioned.

The FRAX and/or CAROC (Canadian Association of Radiologists and Osteoporosis Canada) tools were known by the majority (58/103; 56%), but were rarely used (FRAX by 11, CAROC by 26). Twenty-three of 30 (77%) FPs aware of CAROC found it easy to use, compared to only 14 of the 28 (50%) knowledgeable about FRAX; 9 (32%) found FRAX difficult to use. Of those FPs using FRAX and/or CAROC, 25 (68%) felt they were useful to convince patients to get treated.

Two thirds (69/103) of the responding FPs already collaborated with GMF nurses to manage patients with chronic diseases, but only 6 were doing so for OP patients.

Conclusions After 4 years of existence, the OPTIMUS initiative appears to progressively overcome the previously BMD-driven decision of FPs and to prioritize a post-FF intervention to treat osteoporosis. Fracture risk calculators remain infrequently used but may be useful to convince patients to get treated. There is an opportunity to integrate/systematize the management of FF patients in groups of FPs with the help of GMF nurses, as these nurses are already involved in management of other chronic diseases.

Disclosure of Interest None Declared

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