Authors (including presenting author) :
Yeung HMT(1), Loo KM(1), Fong SL(1), Chan NS(2), Wong HM(2), Ozaki R(1), Cheung KT(1)
Affiliation :
(1)Department of Medicine & Therapeutics, Prince of Wales Hospital (2)Department of Physiotherapy, Prince of Wales Hospital
Introduction :
Osteoporosis is a chronic metabolic bone disease characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequently a higher fracture risk. The statistics from the Census and Statistics Department of HK showed that the osteoporosis cases had increased from 57,800 in 2017 to 79,300 in 2019. Alarmingly, the HA statistics revealed that the incident of fragility fracture in 2014 was higher than that for acute MI or CVA. Osteoporosis imposes a heavy burden on patients and the healthcare system. In 2020, there were about 10,000 hip fracture hospital admissions each year which on average involved a healthcare cost of HK$100,000 per case. Amongst these cases, approximately half of them sustained permanent mobility impairment, half went to elderly care home. Furthermore, one-fifth of them died within 1 year. Osteoporosis and its complications are highly preventable. Without an advocated multidisciplinary team approach, patients will fail to adhere to the prescribed treatment. With the continued growth of the aging population, there is a need to prevent fragility fractures. The establishment of the integrated nurse clinic has a pivotal role in supporting physicians in managing osteoporosis. In July 2021, the first osteoporosis integrated nurse clinic was set up at PWH.
Objectives :
The aims of our novel integrated service model for osteoporosis care: - •Deliver a structured care management through a multidisciplinary team approach. •Improve continuity of care •Monitor medication response and side effects. •Prevent fractures. •Raise public awareness •Reduce waiting time, hospitalization, mortality and morbidity
Methodology :
The clinic focuses on: •New case assessment (newly referred to SOPC): Nurses perform history taking and arrange relevant investigations for newly referred patients to the Medical SOPC prior to their first medical appointment in order to facilitate physicians in formulating a treatment plan •Structured educational program for existing cases managed at SOPC: Patients are educated on drug administration and its side-effects, lifestyle modifications, nutritional intake, weight-bearing exercise, dental health and their DXA results. They will be referred to attend dietetic and physiotherapy classes. Nurses may arrange for DXA scans (with physicians’ support) for continuing osteoporosis surveillance.
Result & Outcome :
From July 2021 to December 2022, 2111 patients attended the clinic (126 new cases, 1985 existing SOPC cases). 560 and 514 cases were referred to dietitians and physiotherapists respectively. The mean scores of satisfaction survey on disease management education and nurse clinic service are 3.52 and 3.75(n=451, highest score=4). Overall, there was an improvement in patients’ knowledge on osteoporosis(Pre-test 51% vs Post-test 78%)
