Fragility Fracture Network - FFN

Transcription

1 Fragility Fracture Network - FFN A Global Multidisciplinary Network to Improve Fragility Fracture Management and Prevention Ami Hommel RN, CNS, PhD, Associate Professor Lund University & Skane university hospital, Lund, Sweden Chair International Collaboration of Orthopaedic Nursing Scientific Board member, the Fragility Fracture Network

2 Hip Fractures Are the Key Hip fractures 87% of total cost of all fragility fractures Often considerably increased dependency

3 Age Adapted from Kanis JA, Johnell O; 1999 Morbidity Dependence The fragility fracture career - a chronic disease Age No fractures increasing morbidity due to ageing alone

4 Age Adapted from Kanis JA, Johnell O; 1999 Morbidity The fragility fracture career - a chronic disease Dependence Hip fracture Colles' fracture Vertebral fracture Added morbidity from fractures No fractures increasing morbidity due to ageing alone Age

5 Despite falling age-adjusted incidence, ageing will lead to massive increase in burden over the next 25 years Double the number of cases Treble the cost Unless we do something about it

6 Projected Osteoporotic Hip Fractures Worldwide Total number of hip fractures: 1990 = 1.66 million 2050 = 6.26 million Adapted from Cooper C et al, Osteoporosis Int, 1992; 2:285-9

7 Mission To promote globally the optimal multidisciplinary management of the patient with a fragility fracture, including secondary prevention

8 Aims to disseminate globally the best multidisciplinary practice in preventing and managing fragility fractures to promote research aimed at better treatments for osteoporosis, sarcopenia and fracture to drive policy change that will raise fragility fractures higher up the healthcare agenda in all countries

9 Membership Open to professionals in any field relevant to fragility fractures, eg: Orthopaedic surgeons Other doctors: geriatricians, osteoporosis doctors etc Nurses and allied health professionals Scientists Industry Application for membership via the website

10 Members by global region 45% 43% 40% 35% 30% 25% 20% 15% 10% 5% 12% 14% 13% 12% 4% 0% Europe North America ANZ Asia Middle East Latin America

11 Members by discipline 50% 44% 40% 30% 31% 20% 10% 1% 3% 11% 6% 5% 0%

12 First Global Congress 6-8 Sep 2012 Berlin Attended by >350 Workshops

13 First Global Congress 6-8 Sep 2012 Berlin Attended by >350 Workshops Second Global Congress August 2013 Berlin Attended by >400 Workshops

14 Progress Blue Book on fragility fracture care National Hip Fracture Database Sweden started in 1988 Fracture Liaison Services

15 Goals of the NHFD To change clinical behaviour raise standards To raise the political profile of fragility fractures To provide a platform for clinical research

16 Four big messages Multidisciplinary approach to the management of fragility fracture patients Reliable secondary prevention Osteoporosis and falls Chronic disease model Quality assurance the NHFD

17 Six standards for hip fracture care 1. All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of presentation (2h) 2. All patients with hip fracture who are medically fit should have surgery within 48 hours of admission, during normal working hours (24h) 3. All patients with hip fracture should be assessed and cared for with a view to minimising their risk of developing a pressure ulcer 4. All patients presenting with a fragility fracture should be managed on an orthopaedic ward with routine access to orthogeriatric medical support from the time of admission 5. All patients presenting with fragility fracture should be assessed to determine their need for antiresorptive therapy to prevent future osteoporotic fractures 6. All patients presenting with a fragility fracture following a fall should be offered multidisciplinary assessment and intervention to prevent future falls

18 Package for older people Top priority Hip fracture patients Non-hip fragility fracture patients Individuals at high risk of 1 st fragility fracture or other injurious falls Older people Objective 1: Improve outcomes and improve efficiency of care after hip fractures by following the 6 Blue Book standards Objective 2: Respond to the first fracture, prevent the second through Fracture Liaison Services in acute and primary care Objective 3: Early intervention to restore independence through falls care pathway linking acute and urgent care services to secondary falls prevention Objective 4: Prevent frailty, preserve bone health, reduce accidents through preserving physical activity, healthy lifestyles and reducing environmental hazards

19 Prevent next fracture We need to prevent hip fractures as well as treat them well if they happen By responding to earlier fractures we could reduce the future incidence by ~25% This requires a Fracture Liaison Service model Can a FLS-database drive change similarly? 19

20 Age Adapted from Kanis JA, Johnell O; 1999 Morbidity Earlier fractures signal the hip fracture Dependence Hip fracture Colles' fracture Vertebral fracture Added morbidity from fractures No fractures increasing morbidity due to ageing alone Age

21 Secondary prevention Secondary prevention is more costeffective than primary prevention

22 Percentage Prevalence of prior fractures among patients presenting with hip fracture n=2124 n=632 n= Lyles et al Edwards et al Mclellan et al Lyles KW et al. The Horizon Recurrent Clinical Fracture after Recent Hip Fracture Trial (RFT) Study Cohort Description. ASBMR 2006 Edwards, B. J. et al (2007) Prior Fractures Are Common in Patients With Subsequent Hip Fractures. Clinical Orthopaedics & Related Research, 461, McLellan Alastair R. et al.(2004) Effectiveness of Strategies for the Secondary Prevention of Osteoporotic Fractures in Scotland (CEPS 99/03). NHS Quality Improvement Scotland.

23 Percentage National Clinical Audit of Falls and Bone Health (2007) Clinical Effectiveness and Evaluation Unit, RCP, London Interventions after fragility fracture Target 100% 100% 100% ~70% hip (n = 3184) non-hip (n = 5642) 0 Osteoporosis assessment DXA referral (65-74 years) Supplementation with calcium + D3 Treatment with osteoporosis medication

24 Capturing patients reliably Employment of a dedicated coordinator in the fracture service is the most effective system

25 McLellan et al OI 2003, 14: NEW FRACTURE INPATIENT ORTHO/TRAUMA WARD OUTPATIENT FRACTURE CLINIC FALLS RISK ASSESSMENT EXERCISE CLASSES Rx FOR FRACTURE 2 Y PREVENTION EDUCATION PROGRAMME PRESCRIPTION ISSUED BY GP

26 Secondary prevention Secondary prevention is more effective than primary prevention A systems approach is needed, where capture of patients is automatic When it is done vigorously, it is cost-saving

27 Cost-saving Per 1000 fragility fracture patients, 18 fractures (11 hip) prevented net saving 21,000

28 Central role of nurses Acute care of elderly fracture patients Pathways Orthogeriatric liaison Trauma coordinator Secondary prevention FLNs in fracture units FLNs in primary care Falls prevention

29 The FFN needs nurses Only way to cope with the numbers Many parts of the world where nurses not allowed much independent action Great opportunity to spread good practice Next Global Congress in Madrid 4-6 th Sep