Characterization of fracture liaison service non-responders after invitation by home visits and questionnaires
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ORIGINAL ARTICLE
Characterization of fracture liaison service non-responders after invitation by home visits and questionnaires P. van den Berg 1
&
P.M.M. van Haard 2 & P.P. Geusens 3,4 & J.P. van den Bergh 3,4,5 & D.H. Schweitzer 6
Received: 11 February 2020 / Accepted: 29 April 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary This study aimed to gain insight in specific characteristics and beliefs of FLS non-responders. Introduction The proportion of non-responding fracture liaison service (FLS) invitees is high but characteristics of FLS nonresponders are unknown. Methods We contacted FLS non-responders by telephone to consent with home visit (HV) and to fill in a questionnaire or, if HV was refused, to receive a questionnaire by post (Q), to gain insight in beliefs on fracture cause and subsequent fracture risk. Results Out of 716 FLS invitees, 510 attended, nine declined, and 197 did not respond. Of these non-responders, 181 patients were consecutively traced and phoned until 50 consented with HV. Forty-two declined HV but consented with Q. Excluded were eight Qconsenters in whom no choice was offered (either HVor Q) and 81 patients who declined any proposition (non-HV|Q). 62% HVand Q could recall the FLS invitation letter. The fracture cause was differently believed between HVand Q; the fall (96% versus 79%, p = .02), bad physical condition (36% versus 2%, p = .0001), dizziness or imbalance (24% versus Q 7%, p = .03), osteoporosis (16% versus 2%, p = .02), and increased fracture risk (26% versus 17%, NS). Age ≥ 70, woman, and major fracture were significantly associated with HV consent compared to Q (OR 2.7, 2.5, and 2.4, respectively) and HV compared to non-HV|Q (OR 16.8, 5.3, and 6.1). Conclusion FLS non-responders consider fracture risk as low. Note, 50 patients (about 25%) consented with a home visit after one telephone call, mainly older women with a major fracture. This non-responder subgroup with high subsequent fracture risk is therefore approachable for secondary fracture prevention. Keywords FLS . Home visit . Non-respondence . Non-attendance . Osteoporosis . Questionnaire
Introduction Osteoporosis care in patients with a recent fracture has been improved by the introduction of the Fracture Liaison Service * P. van den Berg [email protected] 1
Department of Orthopedics and Trauma surgery, Fracture Liaison Service, Reinier de Graaf Hospital, Delft, The Netherlands
2
Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Hospital, Delft, The Netherlands
3
Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
4
Hasselt University, Hasselt, Belgium
5
Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
6
Department of Internal Medicine and Endocrinology, Reinier the Graaf Hospital, Delft, The Netherlands
model (FLS). This hospital initiative is firstly reported by McLellan et al. [1] and as such gradually
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