The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years.

Autor: Cianferotti L; Italian Bone Disease Research Foundation (FIRMO), Florence, Italy., Porcu G; Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. gloria.porcu@unimib.it.; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. gloria.porcu@unimib.it., Ronco R; Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. raffaella.ronco@unimib.it.; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. raffaella.ronco@unimib.it., Adami G; Rheumatology Unit, University of Verona, Verona, Italy., Alvaro R; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy., Bogini R; Local Health Unit (USL) Umbria, Perugia, Italy., Caputi AP; Department of Pharmacology, School of Medicine, University of Messina, Sicily, Italy., Frediani B; Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy., Gatti D; Rheumatology Unit, University of Verona, Verona, Italy., Gonnelli S; Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy., Iolascon G; Department of Medical and Surgical Specialties and Dentistry, University of Campania 'Luigi Vanvitelli', Naples, Italy., Lenzi A; Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy., Leone S; AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy., Michieli R; Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy., Migliaccio S; Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy., Nicoletti T; CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy., Paoletta M; Department of Medical and Surgical Specialties and Dentistry, University of Campania 'Luigi Vanvitelli', Naples, Italy., Pennini A; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy., Piccirilli E; Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy.; Department of Orthopedics and Traumatology, 'Policlinico Tor Vergata' Foundation, Rome, Italy., Rossini M; Rheumatology Unit, University of Verona, Verona, Italy., Tarantino U; Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy.; Department of Orthopedics and Traumatology, 'Policlinico Tor Vergata' Foundation, Rome, Italy., Brandi ML; Italian Bone Disease Research Foundation (FIRMO), Florence, Italy., Corrao G; Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy., Biffi A; Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. annalisa.biffi@unimib.it.; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. annalisa.biffi@unimib.it.
Jazyk: angličtina
Zdroj: Archives of osteoporosis [Arch Osteoporos] 2023 Aug 21; Vol. 18 (1), pp. 109. Date of Electronic Publication: 2023 Aug 21.
DOI: 10.1007/s11657-023-01316-9
Abstrakt: Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline.
Purpose: After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines.
Methods: PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance.
Results: Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures.
Conclusions: Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.
(© 2023. The Author(s).)
Databáze: MEDLINE
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