FLS Renewal Form Audit J Weldon (OOS) Step 1 of 5 20% Section 1: Information about your FLS programFor any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.caPerson submitting this form: First name Last name Email of submitter Section 2: Type of FLS2. a. Method by which the majority (> 50%) of the fragility fracture patients are identified/captured/enrolled in your FLS.(Click only one answer)a. Referrals are sent to/received by the FLS.b. The FLS coordinator does systematic and pro-active case finding of the fragility fracture patients.c. Other.Please describe the referral process including the estimated number and type of healthcare providers who refer to your FLS.Please briefly describe the process for systematic and pro-active case finding for patients admitted to hospital with a fragility fracture (if applicable).Please briefly describe the process for systematic and pro-active case finding for patients seen in the hospital’s orthopaedic outpatient clinics (if applicable).Please describe how the majority (> 50%) of the patients are identified/captured/enrolled in your FLS.2. b. Type of FLS (Assumption: We assume all OOS sites are outpatient-only. For the OOS sites which are different, please check box and then list name of the site): a. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients. b. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the inpatient ward). Our FLS enrolls more than just hip fracture patients. c. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic). d. Other (some combination not listed) Please list inpatient-only (hip only) sites:Please list inpatient-only (more than hip fractures) sites:Please list (combined) sites:Other, please elaborate:2. c. Briefly describe your model, including how the systematic and pro-active case finding occurs. Section 3: FLS Processes3. a. What fracture risk determination tool is used by your FLS in the majority (> 50%) of FLS patients?(Click only one answer)a. Our FLS only includes hip fracture patients. All patients with a fragility hip fracture are deemed HIGH RISK.b. CAROCc. FRAX with BMDd. FRAX without BMDe. OtherIf other, please specify3. b. In your FLS, who is responsible for ordering the patient’s BMD in the majority (> 50%) of cases?(Click only one answer) a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.b. FLS coordinatorc. FLS medical leadd. Patient’s orthopaedic surgeon, coordinated by the FLS coordinatore. Patient’s orthopaedic surgeon, at their discretionf. A letter is sent out to the patient’s primary care provider with a strong recommendation to do a BMD test. The BMD is ordered by the patient’s primary care provider.g. Other, please specify.If other, please specify3. c. In your FLS, who determines the fracture risk for the majority (>50%) of the FLS patients?(Click only one answer)a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.b. FLS coordinatorc. FLS medical leadd. The radiologist who interprets the BMD teste. Other, please specify:If other, please specify:3. d. For the majority (> 50%) of the patients seen by your FLS who are deemed to be HIGH RISK, who prescribes the first-line osteoporosis medication?(Click only one answer)a. All HIGH RISK patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist prescribes the osteoporosis medication.b. FLS coordinatorc. FLS medical leadd. Patient’s orthopaedic surgeon, coordinated by the FLS coordinatore. Patient’s orthopaedic surgeon, at their discretionf. A letter is sent out to the patient’s primary care provider with a strong recommendation to initiate first-line osteoporosis treatment. The medication is prescribed by the patient’s primary care provider.g. The BMD report goes directly to the patient’s primary care provider. The primary care provider can make a decision regarding the need for osteoporosis treatment based on the BMD results.h. Other, please specify.If other, please specify:3. e. For HIGH RISK patients, what is included in the communication from the FLS to the patient’s primary care provider?(Click all that apply) a. The patient’s fracture risk (High, Moderate or Low) b. The results of any investigations done. c. The name of the osteoporosis medication prescribed by the FLS. d. A strong recommendation to initiate and/or continue osteoporosis medication. e. A list of first-line osteoporosis medications as per OC’s 2010 Osteoporosis Guidelines. f. Other If other, please specify:3. f. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?a. Our FLS provides the prescription to the patient directly.b. Patient self-report upon follow-up visit or phone call.c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.d. OtherPlease specify database:If other, please specify:PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture. 3. g. Do your FLSs monitor persistence at 52 weeks post fracture?YesNoADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. • For oral bisphosphonates (alendronate/risedronate), it is defined as: o Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND o Also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections. 3. h. Do your FLSs monitor adherence?YesNo Section 4: Annual Enrollment Data4. Including only those OOS sites which are listed on the OC FLS Registry, please provide the total/aggregate number of fracture patients enrolled in your OOS FLSs from April 1, 2019 to March 31, 2020.FRACTURE NUMBERS-of the above number, how many were:a. Hip (proximal femur) fracturesb. Wrist (distal radius) fracturesc. Shoulder (proximal humerus) fracturesd. Pelvic fracturese. Spine/vertebral fractures Section 5: PermissionThank you for your collaboration.*Osteoporosis Canada may use aggregate data from this audit for possible publication and/or research purposes. The individual FLS sites would remain completely anonymous in the event of any publication.I consent to the use of the data collected in this questionnaire for the purpose stated above.I do not consent to the use of the data collected in this questionnaire for the purpose stated above.
