Advanced Osteoporosis Triage System Shortens the Waiting Time for Osteoporosis Clinic

Abstract

Introduction Osteoporosis has become a major health problem both locally and worldwide. The waiting time for specialist clinics has inevitably risen because of our aging population. An effective healthcare referral system is required to meet the growing demand of service. To maintain a good standard of patient care, an Advanced Osteoporosis Triage System (AOTS) has been commenced since 2012. Objectives (1) To evaluate the effectiveness of the AOTS; and (2) to monitor the waiting list in osteoporosis specialist clinic. Methodology Patients with osteoporosis referred to osteoporosis specialist clinic between January 2012 and January 2014 were assessed by the AOTS. An experienced nurse in the field of osteoporosis, functioning as the case manager, would work with reference to a clinical management protocol under the supervision of an endocrinologist. Patients were triaged to high-risk and nonhigh- risk group based on various criteria including their latest clinical informations like presence of fracture, recent fall and drug history; the Fracture Risk Assessment Tool (FRAX) score; investigations results such as bone mineral density, blood tests for vitamin D, thyroid and parathyroid hormone levels etc. Clinical information was verified from the hospital’s Computer Medical System (CMS) and updated by a structured telephone interview. The waiting time for a medical consultation in the clinic among high-risk group and non-high-risk group were compared to a historical control group, which included the patients being seen in the clinic before implementation of the AOTS. Results 1,689 patients with 32 male (2%) and 1,654 female (98%), were referred during the period studied. The mean age of the patient was 75±11 years. 331 patients (20%) were triaged to high-risk group. Patients being triaged to the high-risk group included those with secondary causes of osteoporosis identified, such as vitamin D deficiency (number=131, 40%), thyroid disease (number=26, 8%), primary hyperparathyroidism (number=7, 2%); those with high fracture risk as reflected by FRAX score (number=7, 2%); those with recent history of fracture (number=28, 9%) or recurrent fall (number=5, 1%); and those with comorbid medical conditions, such as impaired renal function (number=61, 18%), diabetes (number=14, 4%) or intolerance to anti-osteoporosis drugs (number=46, 14%). Education, further investigations, and appropriate referral were arranged by the case manager before medical consultation in osteoporosis clinic. After the implementation of AOTS, the waiting time for osteoporosis specialist clinic in high-risk group were significantly shortened (15±3 versus 28±2 weeks) (p<0.05) compared with the control group. The waiting time of the non-high-risk group has been maintained and showed no significant difference from the control (28±1 weeks versus 28±2 weeks) (p=0.17). The AOTS demonstrates an effective model which enhances the provision of specialist service to the most appropriate patients in a more timely way. Not only can shorten the clinic waiting time but also help in early identification of underlying diseases.