A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada

Summary — This study evaluated a multi-component intervention (educational materials and outreach visits) to increase knowledge and improve post-fracture care management in five rural communities in Canada. One hundred and twenty-five patients pre- intervention and 149 post-intervention were compared. No significant improvement in post-fracture care was documented suggesting that a more targeted intervention is needed.

Introduction — Currently, the majority of patients with a low trauma fracture are under-investigated and under-treated for osteoporosis. We set out to evaluate an educational intervention on increasing knowledge of post-fracture care among healthcare professionals (HCPs) and fracture patients and on improving post-fracture management.

Methods — We studied five rural communities in Ontario, Canada, using a multi-component intervention (“Behind the Break”), including educational material for HCPs and patients and educational outreach visits to physicians. The study had a historical control, non-equivalent pre/post design. Telephone surveys were carried out with individuals ≥40 years of age who had a low trauma fracture in 2003 (n = 125) or in 2005 (n = 149). Family physicians and emergency department staff were also surveyed.

Results — A total of 4,207 educational packages were distributed. Seventy-three percent of family physicians had an outreach visit. Two-thirds indicated that they received enough information about post-fracture follow-up to incorporate it into their practice. Despite this, no significant improvement in post-fracture care was documented (32% in the “pre” group had a bone mineral density test and 25% in the “post“ group). Of those diagnosed with osteoporosis, the majority were prescribed a bone-sparing medication (63% “pre” and 80% “post”).

Conclusion — A more targeted intervention linking fracture patients to their physician needs to be evaluated in rural communities.