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Published in: Osteoporosis International 5/2017

01-05-2017 | Original Article

Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial

Authors: B. Merle, R. Chapurlat, E. Vignot, T. Thomas, J. Haesebaert, A.-M. Schott

Published in: Osteoporosis International | Issue 5/2017

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Abstract

Summary

We conducted a multicenter, randomized controlled trial to evaluate the impact of a population-based patient-centered post-fracture care program with a dedicated case manager, PREVention of OSTeoporosis (PREVOST), on appropriate post-fracture osteoporosis management. We showed that, compared to usual care, BMD investigation post-fracture was significantly improved (+20%) by our intervention program.

Introduction

Our study aims to evaluate the impact of a population-based patient-centered post-fracture care program, PREVOST, on appropriate post-fracture care.

Methods

Multicenter, randomized controlled trial enrolling 436 women aged 50 to 85 years and attending a French hospital, for a low-energy fracture of the wrist or humerus. Randomization was stratified by age, hospital department, and site of fracture. The intervention was performed by a trained case manager who interacted only with the patients, with repeated oral and written information about fragility fractures and osteoporosis management, and prompting them to visit their primary care physicians. Control group received usual care. The primary outcome was the initiation of an appropriate post-fracture care defined by Bone Mineral Density (BMD) and/or anti-osteoporotic treatment prescription at 6 months.

Results

At 6 months, 53% of women in intervention group initiated a post-fracture care versus 33% for usual care (adjOR 2.35, 95%CI [1.58–3.50], p < 0.001). Post-fracture care was more frequent after wrist than humerus fracture (adjOR 1.93, 95%CI [1.14–3.30], p = 0.015) and decreased with age (adjOR for 10 years increase 0.76, 95%CI [0.61–0.96], p = 0.02). The intervention resulted in BMD prescription in 50% of patients (adjOR 2.10, 95%CI [1.41–3.11], p < 0.001) and in BMD performance in 41% of patients (adjOR 2.12, 95%CI [1.40–3.20], p < 0.001) versus 33 and 25% for usual care, respectively. Having performed a BMD increased treatment prescription; however, only 46% of women with a low BMD requiring a treatment according to the French guidelines received a prescription.

Conclusion

A patient-centered care program with a dedicated case manager can significantly improve post-fracture BMD investigation.
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Metadata
Title
Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial
Authors
B. Merle
R. Chapurlat
E. Vignot
T. Thomas
J. Haesebaert
A.-M. Schott
Publication date
01-05-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 5/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-017-3953-z

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