Prevención secundaria de fracturas tras fractura de fémur en el área norte de Gran Canaria: comparativa 2004-2014 / Secondary fracture prevention after femur fractures in the Gran Canaria North Health Area: a 2004-2014 comparison

No disponible

Resultados de un modelo de prevención secundaria de fractura osteoporótica coordinado por reumatología centrado en la enfermera y el médico de atención primaria / Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians

Objetivo. Evaluar la influencia de la implantación de un programa para la prevención secundaria de fracturas osteoporóticas sobre la prescripción de bisfosfonatos y la persistencia del tratamiento a corto plazo. Pacientes y métodos. Se incluyeron pacientes con fractura por fragilidad > 50 años atendidos en el servicio de urgencias durante un año. El programa consistió en: 1) plan de formación en osteoporosis de los médicos de primaria; 2) densitometría ósea; 3) cuestionario relativo a osteoporosis y educación del paciente por la enfermera; 4) derivación al médico de primaria o, en caso de múltiples fracturas o precisar terapia parenteral, a consulta hospitalaria; y 5) seguimiento y comprobación de inicio del tratamiento prescrito a través de los registros electrónicos y encuesta telefónica. La variable principal de desenlace fue el porcentaje de pacientes que, habiéndose prescrito un bisfosfonato, cumple el tratamiento a los 3 meses. Resultados. De 532 pacientes con criterios de inclusión, 202 (38%) no aceptaron participar. Comparados con los pacientes que participaron, los que rechazaron tenían una edad promedio mayor (p < 0,01) y una mayor frecuencia de fractura de cadera (p < 0,01). Así, se incluyeron 330 pacientes con una edad media de 71 años, el 77% mujeres. Cuarenta y cinco pacientes (13%) utilizaban bisfosfonato al inicio del estudio, mientras que tras la visita basal se prescribió a 223 pacientes (67%). En el seguimiento a los 3 meses, el 78% de los pacientes a los que se aconsejó bisfosfonato estaba tomando la medicación. Conclusiones. El programa de prevención secundaria de fracturas coordinado por reumatología consigue que el número de pacientes que inicia bisfosfonato se multiplique por 4 en comparación con la visita basal (AU)

Objective: To assess the influence of the implementation of a program for secondary prevention of osteoporotic fractures on prescribing bisphosphonates and persistent short-term treatment. Patients and methods: Patients > 50 years with fragility fracture attended in the emergency department were enrolled in an observational study. The program consisted of: 1) training of primary care physicians, 2) baseline visit: questionnaire on osteoporosis, bone densitometry and patient education, 3) patient referral to primary care, except those with multiple fractures or requiring special study or therapy, who were referred to a specialist, and 4) follow-up by checking prescriptions in electronic records, and a telephone survey. The outcome variable was the percentage of patients who, on having been prescribed bisphosphonates, still adhered to the treatment at 3 months. Results: Of the 532 patients with inclusion criteria, 202 (39%) refused to participate. Those who refused to take part had a higher mean age ( P < .01) and a higher frequency of hip fracture (P < .01) compared with patients who did participate. A total of 330 patients were included for intervention, with a mean age of 71 years, and 254(77%) were female. An antiresorptive was being used by 45 patients (13%) at baseline. After the baseline visit 223 patients (67%) were recommended a bisphosphonate. In the follow-up at 3 months 78% of patients who had been prescribed bisphosphonate were still receiving treatment. Conclusions: We present a multidisciplinary program for secondary prevention of fractures coordinated by rheumatology in which the number of patients who were receiving bisphosphonate at 3 months increased by four times compared to baseline visit (AU)

Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians.

OBJECTIVE: To assess the influence of the implementation of a program for secondary prevention of osteoporotic fractures on prescribing bisphosphonates and persistent short-term treatment. PATIENTS AND METHODS: Patients >50 years with fragility fracture attended in the emergency department were enrolled in an observational study. The program consisted of: 1) training of primary care physicians, 2) baseline visit: questionnaire on osteoporosis, bone densitometry and patient education, 3) patient referral to primary care, except those with multiple fractures or requiring special study or therapy, who were referred to a specialist, and 4) follow-up by checking prescriptions in electronic records, and a telephone survey. The outcome variable was the percentage of patients who, on having been prescribed bisphosphonates, still adhered to the treatment at 3 months. RESULTS: Of the 532 patients with inclusion criteria, 202 (39%) refused to participate. Those who refused to take part had a higher mean age (P<.01) and a higher frequency of hip fracture (P<.01) compared with patients who did participate. A total of 330 patients were included for intervention, with a mean age of 71 years, and 254(77%) were female. An antiresorptive was being used by 45 patients (13%) at baseline. After the baseline visit 223 patients (67%) were recommended a bisphosphonate. In the follow-up at 3 months 78% of patients who had been prescribed bisphosphonate were still receiving treatment. CONCLUSIONS: We present a multidisciplinary program for secondary prevention of fractures coordinated by rheumatology in which the number of patients who were receiving bisphosphonate at 3 months increased by four times compared to baseline visit.

Estándares de calidad asistencial para las consultas de enfermería en reumatología / Quality of care standards for nursing clinics in rheumatology

Introducción. Las consultas de enfermería en reumatología (CER) son modelos organizativos asistenciales en el ámbito de competencias de enfermería. Hay diversos modelos de CER, pero no existe una definición operacional. El objetivo del proyecto es elaborar estándares de calidad para definir y caracterizar una CER. Método. Estudio Delphi a 2 rondas. El panel estuvo constituido por 67 expertos: reumatólogos y enfermeras del Grupo de Trabajo de Enfermería de la Sociedad Española de Reumatología (SER). El cuestionario se elaboró tras revisión bibliográfica y experiencias de proyectos previos de la SER. El cuestionario consta de 7 apartados: consideraciones generales, estándares de estructura, de proceso, de tratamiento y seguimiento, educación sanitaria, formación e investigación y calidad asistencial. Cada ítem se puntuó de 1 (menos importante) a 9 (más importante) o mediante una cifra. El grado de acuerdo de los expertos se categorizó según el coeficiente de variación (CV) entre muy alto (CV ≤ 25%) y muy bajo (CV > 100%). Resultados. El cuestionario de la segunda ronda (182 ítems) fue respondido por 46 panelistas (34 reumatólogos y 12 enfermeras). Se obtuvo un grado de acuerdo muy importante en los estándares generales, de estructura, de proceso, de tratamiento y seguimiento, educación sanitaria y calidad asistencial. Se encontró menor acuerdo en los estándares relacionados con el tiempo para formación, el número de proyectos de investigación propios de enfermería y de publicaciones recomendables. Conclusión. Los estándares desarrollados en este estudio permitirían establecer mínimos deseables de calidad de estructura, proceso, labor asistencial, investigadora y docente que se pueden utilizar para desarrollar y evaluar las CER (AU)

Background. Nursing clinics in rheumatology (NCR) are organizational models in the field of nursing care. There are various NCR models, but there is no consensus on its operational definition. Our objective is to develop quality standards to define and characterize a NCR. Method. Two-round Delphi method. The panel consisted of 67 experts: rheumatologists and nurses of the nursing working group of the Spanish Society of Rheumatology (SSR). The Delphi questionnaire was developed after a literature and experience review from previous SSR projects. The questionnaire consists of 7 sections: general considerations, standards of structure, process, treatment and monitoring, health education, training and research and quality of care. Each item was scored from 1 (least important) to 9 (most important) or by assigning a number (e.g. waiting days). The degree of agreement among the experts was categorized according to the coefficient of variation (CoV) between very high (CoV≤25%) and very low (CoV>100%). Results. The second round questionnaire (182 items) was answered by 46 panelists (34 rheumatologists and 12 nurses). A very important agreement was reached on the general standards of structure, process, treatment and monitoring, health education and quality of care. Less agreement was observed on standards related to training time, number of recommended nurses’ research projects and publications. Conclusion. The standards developed in this study would be useful for establishing desirable quality standards of structure and process, and criteria for clinical work, research and teaching that can be used to develop and evaluate the NCRs (AU)

Quality of care standards for nursing clinics in rheumatology.

BACKGROUND: Nursing clinics in rheumatology (NCR) are organizational models in the field of nursing care. There are various NCR models, but there is no consensus on its operational definition. Our objective is to develop quality standards to define and characterize a NCR. METHOD: Two-round Delphi method. The panel consisted of 67 experts: Rheumatologists and nurses of the nursing working group of the Spanish Society of Rheumatology (SSR). The Delphi questionnaire was developed after a literature and experience review from previous SSR projects. The questionnaire consists of 7 sections: general considerations, standards of structure, process, treatment and monitoring, health education, training and research and quality of care. Each item was scored from 1 (least important) to 9 (most important) or by assigning a number (e.g., waiting days). The degree of agreement among the experts was categorized according to the coefficient of variation (CoV) between very high (CoV≤25%) and very low (CoV>100%). RESULTS: The second round questionnaire (182 items) was answered by 46 panelists (34 rheumatologists and 12 nurses). A very important agreement was reached on the general standards of structure, process, treatment and monitoring, health education and quality of care. Less agreement was observed on standards related to training time, number of recommended nurses' research projects and publications. CONCLUSION: The standards developed in this study would be useful for establishing desirable quality standards of structure and process, and criteria for clinical work, research and teaching that can be used to develop and evaluate the NCRs.