CAPTURE--THE--FRACTURE(捕获骨折).pptx

CAPTURE THE FRACTURE A GLOBAL CAMPAIGN TO BREAK THE FRAGILITY FRACTURE CYCLEwww.iofbonehealth.org 2012 World Osteoporosis Day5/2/202425/2/202431.Forward5/2/20244Forward全球全球Every 3s25,000/day9M/year欧洲欧洲32 billion EUR/year 美国美国20 billion USD/year中国中国 hip fractures1.6 billion 0612.5 billion 20265 billion 505/2/20245ForwardFracture begets fractureEffective medicines to reduce fractures.Regrettably,by missing the opportunity to respond to the first fracture,healthcare systems around the world are failing to prevent the second and subsequent fractures.5/2/20246ForwardThis report aims to engage:patients and their societies;healthcare professionals and their organizations;policy makers and their governments to close the secondary fracture prevention care gap throughout the world.The opportunity is too good to miss!5/2/202472.WHY SECONDARY FRACTURE PREVENTION MUST BE A PUBLIC HEALTH PRIORITY5/2/20248Why secondary fracture prevention must be a public health priorityFragility fractures:a burden for patients,healthcare systems and national economies Silent High morbidity,mortality and costs Fracture begets fracture 5/2/202495/2/2024103.SECONDARY FRACTURE PREVENTION An opportunity to break the fragility fracture cycle 5/2/202411SECONDARY FRACTURE PREVENTION an opportunity to break the fragility fracture cycle Half of hip fracture patients have suffered prior fragility fractures.One sixth of postmenopausal women have suffered a fragility fracture.5/2/202412Secondary fracture prevention an opportunity to break the fragility fracture cycle 5/2/2024134.THE WORLDWIDE PROBLEM The current care gap 5/2/202414THE WORLDWIDE PROBLEM The current care gap Many professional organization guidelines and national prescribing and reimbursement policies provide endorsement and funding mechanisms for secondary preventive therapy Documented standards of care in countries where national audit work has been done are summarized below.Australia;Canada;Germany;Switzerland;the Netherlands;Sweden;UK;USA;5/2/202415The Worldwide Problem the current care gap United States A 2007 study of data from National Health and Nutrition Examination Survey(NHANES)estimated that 17%of older women who have sustained a fragility fracture in the United States are receiving osteoporosis treatment.Another study evaluated osteoporosis treatment of 51 346 hip fracture patients admitted to 318 hospitals across the United States.The authors reported that 6.6%of patients received calcium and vitamin D supplements,7.3%received antiresorptive or bone-forming drugs and only 2%received a combination of these therapies,the approach advocated as optimal in most guidelines worldwide.In an associated editorial98,Dr.Robert Adlers conclusion sign-posts the solution to this universal problem that will be considered in detail in the next section of this report:“There are several different performance measures for management of osteoporosis after fracture,and most institutions would fail.A small investment in a fracture coordinator can result in appropriate diagnostic and therapeutic management of patients who have suffered fractures.This should result in fewer fractures and perhaps fewer deaths.Surely we can do better.“5/2/202416WHY IS SECONDARY FRACTURE PREVENTION NOT HAPPENING?5/2/2024172004 Elliot-Gibson Cost concerns relating to diagnosis and treatment Time required for diagnosis and case-finding Concerns relating to polypharmacyLack of clarity regarding where clinical responsibility resides2006 Giangregorio Treatment was offered more frequently for patients with vertebral fractures in comparison to patients with non-vertebral fracturesOlder patients were more likely to be diagnosed with osteoporosis yet younger patients were more likely to receive treatment Males were less likely to be treated than womenPost-fracture falls assessment are not often conducted and rarely reported as an outcome of the studiesProfessor TimothyHarringtons metaphorical depictionOsteoporosis care of fracture patients has been characterized as the Bermuda Triangle made up of orthopaedists,primary care physicians,and osteoporosis experts into which the fracture patient disappears.5.A PROVEN SOLUTION Coordinator-based,post-fracture models of care 5/2/202418A proven solution-coordinator-based,post-fracture models of care In 2011,the Fracture Working Group of the Committee of Scientific Advisors of IOF published a position paper on coordinator-based systems for secondary prevention in fragility fracture patients.Exemplar service models:Fracture Liaison Services(UK;Europe and Australia),Osteoporosis Coordinator Programs(Canada)Care Manager Programs(USA).Coordinator-based systems facilitate bone mineral density testing,osteoporosis education and care in patients following a fragility fracture and have been shown to be cost-saving5/2/202419A proven solution-coordinator-based,post-fracture models of care 5/2/2024206.LOBBYING FOR CHANGEThe impact of effective multi-sector coalitions5/2/202421Lobbying for changethe impact of effective multi-sector coalitionsDuring the first decade of this century,a consensus has emerged across the world on the need for prioritisation of secondary fracture prevention into national guidance and policy.Australia;Canada;UK USA5/2/202422LOBBYING FOR CHANGEThe impact of effective multi-sector coalitionsCanada Secondary fracture prevention is a central component of the Ontario Osteoporosis StrategyThe strategy is made up of five components being implemented at a population-based level:1Health Promotion 2Screening:3Post-Fracture Care:4Professional Education:5Research and Education:5/2/202423In March 2011,Osteoporosis Canada published a White Paper titled Osteoporosis:Towards a fracture free futureThe White Paper is completely focused on the need to close the secondary prevention care gap across Canada and is founded on four key components:1.A systematic top-down approach to fragility fracture prevention 2.An Osteoporosis Patient Bill of Rights demands that the post fracture care gap be addressed 3.Multidisciplinary Clinical Practice Guidelines which address the post-fracture care gap and make recommendations on cost-effective solutions 4.Coordinated post-fracture care programmes using Case Management are recommended as the most cost effective programmes to reduce fractures rates,including hip fracture rates5/2/2024247.IMPLEMENTATION GUIDELINES&RESOURCESFor healthcare professionals,national patient societies and policy makers5/2/2024257.implementation guidelines&resourcesfor healthcare professionals,national patient societies and policy makersSteps to establish a coordinator-based,post-fracture model of careApplication of plan-do-study-act methodology to service developmentFracture patient case-finding systems 5/2/2024268.STRATEGIC APPROACHES For national patient societies,professional organizations and policy makers 5/2/202427Audit of services for secondary fracture prevention Developing consensus guidelines 5/2/2024289.KEY FACTS FOR POLICY MAKERS5/2/202429The problemOpportunities for secondary preventive interventionThe current care gapThe solution:coordinator-based post-fracture models of care5/2/20243010.THE IOF CAPTURE THE FRACTURE CAMPAIGN Capture the Fracture is a global campaign developed to facilitate the implementation of coordinator-based,post-fracture models of care for secondary fracture prevention.The International Osteoporosis Foundation(IOF)believes this is the single most important thing that can be done to directly improve patient care and reduce spiralling fracture related healthcare costs worldwide.5/2/202431