Approaches to organization of Fracture Liaison Services at the regional level with the involvement of primary care physicians

Abstract

To prevent fractures which the elderly and the very old might deal with is a strategic task for preserving the life quality of the elderly and their independence from outside help, as well as reduce the health care and social support economic costs. The most effective and cost-effective organizational structure for reducing fractures frequency is the Fracture Liaison Service (FLS). The foundation of FLS at the regional level includes various models of these services, which is associated with a multi-level system of trauma care, different numbers of attached population and different number of specialists. Firstly, these are identification, assessment of clinical risk factors for osteoporosis, investigation for secondary osteoporosis causes and treatment initiation in the FLS with follow-up in the primary health care in 12–18 months’ time. Secondly, these are identification, risks assessment, patients’ investigation in the FLS during 3 months with the follow-up treatment initiating by the primary health care physician. And thirdly, these are assessment, investigation and treatment initiation by a primary care doctor immediately after trauma care. In any case of the FLS organization, a patient who has had a fragility fracture in any period after the fracture will be under the supervision of a primary care physician, and therefore additional efforts should be made by healthcare organizers, heads of a medical organization and other specialists in order to increase the identification of the patients with osteoporosis, their examination and treatment with anti-osteoporotic drugs in the primary health care. The article presents the results of the studies confirming the effectiveness of FLS with a coordinator, educational activities for patients and doctors, the role of a traumatologist in motivating a patient for examination and treatment, and other options to help a primary care physician with identifying, diagnosing and treating patients after fragility fractures.