Fracture risk assessment in a primary care population: case finding using routine GP data, FRAX® And RAIDR® in the United Kingdom

2013 ◽  
Author(s):  
Terry Aspray ◽  
Erica Whalley ◽  
Mike Scott ◽  
Steve Summers ◽  
Steve Turley ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
United Kingdom ◽  
Fracture Risk ◽  
Case Finding ◽  
Fracture Risk Assessment ◽  
Primary Care Population ◽  
The United Kingdom

7 Stop Falling Before it Starts: Increasing Access to Multifactorial Falls and Fracture Risk Assessment and Intervention for Older People At Risk of Falls or Early in Their Falls Career Via Proactive Case Finding

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Turner ◽  
S W Parry ◽  
F E Shaw
Keyword(s):  
Risk Assessment ◽  
Older People ◽  
Fracture Risk ◽  
Physical Performance ◽  
Frailty Index ◽  
Target Population ◽  
Case Finding ◽  
Fracture Risk Assessment ◽  
Community Based ◽  
Balance Exercise

Abstract Background Target population: patients from 6 (of 43) Newcastle upon Tyne General Practices, age 65 – 75, mild frailty on electronic frailty index, who had fallen or noticed a balance problem in the previous year. Introduction Usually multifactorial falls and fracture prevention services target frailer older people and intervention begins after a fall or fracture has occurred. There is limited provision of community-based strength and balance exercise. Intervention New service model ‘Stop Falling Before It Starts (SFBIS)’: proactive case finding by postal questionnaire; multifactorial falls and fracture risk assessment by specialist nurse; interventions recommended to General Practitioner (GP); community-based exercise offered to all, predominantly new 15 week ‘Steady On’ strength and balance classes suitable for fitter older people. Methods Data collection: patient characteristics, physical performance (Timed up and Go (TUG), 30 second sit to stand (STS)) before starting and on completion of Steady On classes, service process measures, patient and GP experience. Results 157 patients assessed. 80 (51%) fallen in previous year. 9 (6%) history of syncope / pre-syncope. 18 (11%) orthostatic hypotension. 124 (79%) culprit medications. Recommendations: GP review of history 6 (4%) or medications 13 (8%); referral to secondary care falls service 1 (0.5%); optician assessment 58 (37%); DXA 13 (8%). 131 (83%) referred to Steady On; 119 (91%) attended first class, 61 (51%) completed classes. Mean initial TUG 11 seconds, mean improvement 3 seconds. Mean initial STS 11 repetitions, mean improvement 3 repetitions. Mean patient feedback score 14.6/15 (15 best). GP feedback positive. Conclusions SFBIS was effective in identifying the target population and engaging them in community-based strength and balance exercise classes. Meaningful improvements in physical performance were demonstrated. A smaller number of additional risk factors were identified. There was a high level of satisfaction from patients and GPs. Wider implementation would increase participation in evidence-based community exercise.

scholarly journals P193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary care

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Ashley W Hawarden ◽  
Zoe Paskins ◽  
Erandie Ediriweera Desilva ◽  
Daniel Herron ◽  
Anabelle Machin ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Fracture Risk ◽  
Assessment Tool ◽  
Pilot Trial ◽  
Theoretical Domains Framework ◽  
Opportunity To Learn ◽  
Fracture Risk Assessment ◽  
Structured Interviews ◽  
Patient Interview

Abstract Background The INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community) pilot trial aimed to evaluate the feasibility and acceptability of a nurse-delivered review in primary care for people with inflammatory rheumatological conditions (IRCs), to identify and manage common comorbidities including anxiety and depression, cardiovascular and fracture risk. We report analysis of data focusing on the fracture risk assessment component of the review. Methods Ethical approvals obtained. Semi-structured interviews were conducted to explore experiences of participating in INCLUDE, with 20 patients, the two nurses delivering the intervention and three General Practitioners (GPs) within participating practices. 24 consenting patients had their INCLUDE review recorded for fidelity checking. Selected extracts were played within some interviews to stimulate discussion (tape-assisted recall). Extracts from recorded consultations relating to fracture risk assessment were transcribed and coded. Interviews were digitally recorded, with consent, transcribed and anonymised. Thematic analysis of the interview data was followed by mapping to the Theoretical Domains Framework (TDF). Results Findings mapped to 10/14 TDF domains relating to knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, memory attention and decision processes and environmental context/resources. GPs and nurses identified a lack of knowledge and skills in relation to the identification and management of osteoporosis, due to lack of exposure and repeated changes in clinical guidance. GPs reported differing opinions about whether osteoporosis screening was the role of primary or secondary care. GPs and nurses had differing views about the limits of the nurse role in communicating risk. The INCLUDE nurses reported confidence (self-efficacy) in undertaking FRAX assessments. Nurses valued the opportunity to learn new skills and believed that they were improving patient care. They described practical barriers using FRAX including the difficulty navigating between different IT systems. Nurses described uncertainty over when to refer to the GP. Fidelity checks of recorded reviews, showed that FRAX was appropriately calculated for 22/24 patients; whilst INCLUDE nurses introduced the reason for calculating fracture risk, explanations of the meaning of risk were limited, and patients’ understanding was not always checked and queries not responded to; patient interview findings confirmed patients had limited understanding of the meaning of FRAX. Life-style advice related to bone health was given in few consultations. Conclusion Screening for fracture risk in people with IRCs in a review consultation is acceptable and feasible, although explanations of the meaning of risk assessment could be improved. Integration of a fracture risk assessment tool within GP software would facilitate risk calculation. More work is needed to understand barriers to risk assessment, including clarity over roles and professional boundaries, and develop management pathways to optimise management of fracture risk in people with IRCs. Disclosures A.W. Hawarden None. Z. Paskins None. E. Ediriweera Desilva None. D. Herron None. A. Machin None. C. Jinks None. S. Hider None. C. Chew-Graham None.

scholarly journals DXA and clinical challenges of fracture risk assessment in primary care

2021 ◽  
Vol 88 (11) ◽  
pp. 615-622
Author(s):  
Susan Williams ◽  
Leila Khan ◽  
Angelo A. Licata
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Fracture Risk ◽  
Fracture Risk Assessment

Sclerostin and fracture risk assessment in acromegaly

2019 ◽  
Author(s):  
Jowita Halupczok-Żyła ◽  
Aleksandra Jawiarczyk-Przybyłowska ◽  
Agnieszka Zembska ◽  
Marek Bolanowski
Keyword(s):  
Risk Assessment ◽  
Fracture Risk ◽  
Fracture Risk Assessment
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