An Exploration of Current Primary Care Practice Regarding Osteoporosis Assessment Following a Low Trauma Wrist Fracture in people aged 50 years and above in Wellington, New Zealand: A Quantitative Survey

Abstract

Osteoporosis remains a major health issue worldwide. The impact of the condition and the fractures that can occur, can have significant debilitating impact and also incur substantial financial costs to healthcare systems. The burden of osteoporosis and the rate of osteoporotic fractures in New Zealand is comparable to other countries such as Australia, the United States and Europe. There is global literature evidence dating back as far as 1960, indicating that a fracture sustained after a simple trip or fall can be an indicator of osteoporosis. There is a need to ensure that fracture patients with a potential osteoporosis diagnosis, receive follow up care for assessment to treat any underlying bone health issue to prevent future fragility fractures, particularly, hip fractures. Due to limited formal literature sources describing the associated New Zealand context, the aim of this research work was to explore current practice for osteoporosis assessment following a fragility wrist fracture in the general practitioner (GP) primary health care setting in Wellington, New Zealand.

A quantitative cross-sectional descriptive survey of Wellington GPs was undertaken for this purpose. The reporting of study results were guided by the recommendations detailed within the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement on reporting observational studies (Vandenbroucke et al., 2014). 35 out of 297 GPs from 60 practices in the Wellington region responded to the survey. When describing the local context in Wellington, New Zealand, study results showed that almost three quarters of Wellington GP survey respondents follow up patients who have sustained a potential fragility wrist fracture. The discharge summary was also shown to be a vital part of the communication process between the tertiary and primary health care sectors, acting as a prompt to the GP for further investigation. The single biggest barrier inhibiting processes to enable timely osteoporosis treatment as perceived by GP survey respondents, was lack of public funding, in particular to support availability of diagnostic Dual Energy X-ray Absorptiometry (DEXA) scanning.

Other barriers were identified by the GP survey respondents, such as anti-osteoporosis medication side effects, patient compliance to treatment plans and a lack of time within the scheduled consultation to screen patients for osteoporosis. The main educational resources that a large percentage of GP survey respondents independently accessed on a regular basis, were those that were readily available. These included GP guidelines published by “Osteoporosis New Zealand” and possibly other, and online resources such as “Health Pathways” (a best-practice, condition-specific guideline and information resource for primary health care practitioners - https://3d.healthpathways.org.nz). The results also highlighted that most GP survey respondents preferred to take the lead role in the care for patients needing to undergo osteoporosis investigation and treatment. In addition, the GP survey respondents demonstrated a high level of knowledge regarding osteoporosis risk factors.

In summary, this study has identified features of practice with regards to osteoporosis assessment following a fragility wrist fracture in the Wellington region. In addition, this study has also enabled identification of specific areas that could be better supported and resourced to assist GP’s in the prevention of secondary fragility fractures. These include highly visible public health campaigns to raise public awareness of osteoporosis and education to GP’s regarding the available screening tools. A significant finding was also that the GP respondents in this study indicated they considered that an important part of their role was responsibility for osteoporosis prevention and treatment. The study results also highlight that despite funding issues, GP survey respondents view osteoporosis prevention and treatment as best placed in the care of the primary health care sector.

This is the first New Zealand study that has identified and described the local context around current practice for fragility wrist fracture care within the Wellington GP community, establishing important reference points which can be used to support further development and research.