Abstract
Objectives
To develop a fracture risk Clinical Assessment Protocol (CAP) based on long-term care
(LTC) fracture prevention recommendations and an embedded fracture risk assessment
tool.
Design
A modified Delphi consensus approach including 2 survey rounds and a face-to-face
meeting was implemented to reach consensus on matching of LTC fracture prevention
guideline statements to Fracture Risk Scale (FRS) risk levels.
Setting and Participants
A national panel of recognized experts in osteoporosis, fractures, and long-term care,
including an LTC resident and family members.
Methods
Round 1 survey respondents (n = 24) were provided the LTC fracture prevention guidelines
matched to FRS risk levels and were asked whether they agreed the guideline was appropriate
for the risk level (yes, no, I don't know, I agree with some but not all of it) and
to provide comments. In round 2, guideline statements that did not achieve consensus
(≥80% agreement) were revised consistent with comments provided in round 1 and respondents
were asked again if they agreed with the guideline statement. Statements that did
not achieve consensus were to be discussed and resolved in an in-person meeting (n = 17).
Results
In round 1 (75% response rate), consensus was achieved in 7/14 guideline statements.
In round 2 (56% response rate), 5 statements were revised based on round 1 feedback
and for 2 statements additional information was provided. Consensus was achieved in
all but one statement related to the inappropriateness of pharmacologic therapy for
residents with life expectancy less than 1 year. Following facilitated meeting discussions,
consensus was obtained to revise the guideline statement to reflect that life expectancy
was but one of several criteria that should be used to inform medication decisions.
Conclusions and Implications
An evidence-based fracture risk CAP was developed that will be embedded in international
routine clinical assessment tools to guide fracture prevention in LTC.
Keywords
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Article info
Publication history
Published online: September 21, 2020
Footnotes
This study was supported by a Canadian Institutes of Health Research Planning and Dissemination Grant. The funder had no role in the study, interpretation of data, or decision to submit results.
A.P. has been on the Amgen Advisory Board and has received research support and honoraria from Amgen. J.D.A. has been on the Amgen Advisory Board and has received research support and honoraria from Amgen. J.D.A. has participated in clinical trials sponsored by Amgen and Radius.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
