In the absence of the Fracture Liaison Service (FLS) program in Alberta, it is estimated that fewer than 20% of hip fracture patients undergo diagnosis and therefore, treatment, for osteoporosis. Research conducted locally has demonstrated that interventions and follow-up markedly increases appropriate osteoporosis therapy for patients following a hip fracture. To fill this care gap, Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) has implemented the FLS program for fractured hip patients. The first FLS opened at the Misericordia Community Hospital in Edmonton in June 2015 and has expanded to include six surgical sites across three zones (Edmonton, Central and Calgary). Expansion to South Zone is on the horizon for the 2018/19 fiscal year with province-wide implementation being the end goal.
FLS case management is completed by a dyad encompassing a registered nurse and physician or team of physicians. Different sites have adopted different models with one or several physicians; examples include a geriatrician team, a single hospitalist, or a physician with a special interest in care of the elderly. Following the FLS medical algorithm, patients aged 50 and up who present with a suspected fragility hip fracture are assessed for medication appropriateness, fall risk, and contributing geriatric syndromes, as well as provided education on bone health. Interventions may involve initiating a first line medication, continuing an already prescribed medication, switching to a more appropriate medication, arranging diagnostic and laboratory tests and making referrals to community services such as falls clinics and home care. Osteoporosis experts contribute to recommendations and management of complex cases on a referral basis. The FLS nurse will involve other complementary health care practitioners such as dietetics, geriatrics, pharmacy, physiotherapy, occupational therapy and others as needed in each specific case.
Over the next twelve months, the FLS nurse monitors patients by providing follow-up calls at 3, 6, 9 and 12 months to assess any barriers to compliance to medication or related programs. The FLS nurse may also help secure medication coverage or assist with forms if needed. As part of the assessment and monitoring, the registered nurse will also inform the patient’s primary care physician of steps taken and any test results so they remain updated on the patient and their therapy. Prior to patient discharge after one year from the FLS program, a final handover letter from the program, outlining the plan of ongoing osteoporosis care for the patient, is provided to the primacy care physician.
Alberta’s FLS program is committed to providing evidence based services and maintains a provincial FLS database, much of which is shared with Osteoporosis Canada(OC). Information sharing between Alberta’s FLS and OC is reciprocal; Alberta built its program off the Osteoporosis Canada model and continues to shift and adjust to the changing needs of Albertans. Each zone has a dedicated nurse clinician who facilitates the FLS program in addition to other Fragility and Stability initiatives. The provincial FLS working group has a nurse and physician co-lead team that provide leadership and serve as points of contact for the FLS group as well as external stakeholders. Quarterly and annual reports are produced and the FLS teams meet regularly for education and professional development that contribute to improved patient care. The FLS program continues to strive to improve the quality of life of fractured hip patients, and reducing future fractures.