|Beitragstitel||Co-Treatment of Osteoporosis in elderly Fracture Patients : a Need without Burden for our Budget!|
Introduction. Osteoporosis becomes apparent from a low energy fracture. Secondary fracture prevention should then be applied. This takes place in only 20% of the affected patients. The rate can be improved with a Fracture Liaison Service (FLS): patients aged > 65 who are treated for low energy fractures are only identified from the hospital. The dedicated FLS team then takes the task to organize an osteoporosis workup. The question comes up if this service is self-financed in our healthcare system.
Methods. Our FLS is a cooperation between the clinic for Orthopedic and Trauma Surgery in a public hospital and a private osteoporosis outpatient clinic. Following identification, the FLS team interview the patients in face, consult the electronic medical records and add information from the family physician. This case finding helps to exclude patients in poor general health or patients who denied to take part in an osteoporosis workup. Costs for case finding are being caused by all patients who were identified from the hospital. The reduced patient group includes patients who were found eligible for a first osteoporosis workup as well as patients who had already been subject to osteoporosis diagnostics in the past. These patients are given appointments in the osteoporosis outpatient clinic by the FLS team. This administrative effort is another cost factor. The net financial result calculates from the bills for diagnostics and therapy reduced by 63% for the running costs in the osteoporosis outpatient clinic. Patients who do not show up for an appointment create costs but do not contribute to the financial result of the FLS.
Results. Overall 1270 patients (average age: 81y, average 10y risk for osteoporotic fracture: 27%) were identified in between 01/2014 until 12/2015. 763 patients were excluded, 507 patients were eligible to take part in the osteoporosis workup. Amongst them there were only 24 „No Shows“. 483 patients took part in the osteoporosis workup and therapy according to their needs. The net payback to the FLS was CHF 62.116. The net costs were 20% wage of the FLS nurse and 20% wage for the FLS coordinator, who offered consultations in the osteoporosis outpatient clinic on 127 days X 4h.
Conclusion. Depending on the wage bill of the FLS team the financial result from an FLS can be balanced. Rigorous case finding was found to be “key” in order to avoid unnecessary costs. This finding is important, because new FLS are expected to work self-financed.