Concordance entre les interventions de l’infirmière et de médecins spécialistes dans la prise en charge des fractures de fragilisation
Introduction. Osteoporosis is a chronic condition which is usually asymptomatic until a fragility fracture (FF) occurs. These fractures lead to increased morbidity and mortality in patients. Moreover, a major care gap exists in the investigation for bone fragility and initiation of treatment for individuals who sustain a FF. The implementation of a subsequent fracture prevention program managed by nurses could be the key in resolving these problems.   Objectives. The main objective of this project was to determine if a nurse can manage safely and efficiently a fracture liaison service (FLS).   Methods. Clinical decisions of nurses for 525 subjects in a studied FLS between 2010 and 2012 were assessed by two independent physicians with expertise in osteoporosis treatment.  Results. The nurses succeeded in identifying all patients at risk and referred 26.7% of patients to a specialist.  Thereby, they managed 73.3% of subjects with FF. No needless referrals were made according to both physicians. Agreement between each evaluator and the nurses was of >97%. Physicians’ decisions were the same in >96% for each type of decision and AC1 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.    Conclusion. High agreement between nurses and physicians’ clinical decisions indicate that the management by a nurse of a FLS is safe and recommended for patients with FF. This kind of intervention could help resolve the existing care gap in osteoporosis care as well as the societal economic burden associated with treatment of FF.
osteoporosis fragility fracture nurse clinical nurse specialist case manager management fracture liaison service subsequent fracture prevention