A survey of continued secondary fracture preventive management

Abstract

 The current status of the application and billing of the management fee for continued secondary fracture prevention at medical institutions affiliated to the Japanese Clinical Orthopaedic Association was investigated. Among the hospitals investigated, the percentage of hospitals that had filed reports on the application of this fee was 67.9% for Management Fee 1, 51.8% for Management Fee 2, and 64.3% for Management Fee 3. The patients referred to the hospitals most frequently arrived at the hospitals by ambulance from their home (59%). Treatment of osteoporosis had been started before admission to the hospital in only 21% of the patients. In 35% of the patients, osteoporosis treatment was not started before discharge from the hospital. Patients who had received this kind of management as inpatients were often referred to the outpatient care unit of the same hospital after discharge, indicating that the regional hospital-clinic coalition was not functioning satisfactorily. The number of patients referred to hospitals did not exceed 5 per year at many orthopedic clinics, and 33% of these clinics were not submitting their reports on the application of this fee as they did not satisfy the requirements for Management Fee 3 (pharmacist availability, internal conference system and so on). For prevention of secondary fractures following proximal femoral fracture, it is crucial to continue osteoporosis treatment and to improve the locomotive syndrome (hereinafter called “locomo”) to prevent falls and tumbling; therefore, guidance by practitioners, including by internists serving as family doctors, toward continuation of osteoporosis treatment and control of locomo is essential.