TY - JOUR
T1 - Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall?
T2 - Protocol for a randomised controlled feasibility study
AU - Clarke, Shane
AU - Bradley, Rachel
AU - Simmonds, Bethany
AU - Salisbury, Chris
AU - Benger, Jonathan
AU - Marques, Elsa
AU - Greenwood, Rosemary
AU - Shepstone, Lee
AU - Robinson, Maria
AU - Appleby-Fleming, John
AU - Gooberman-Hill, Rachael
N1 - Funding Information:
1University Hospitals NHS Foundation Trust, Bristol, UK 2Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK 3Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK 4School of Social and Community Medicine, University of Bristol, Bristol, UK 5Norwich Medical School University of East Anglia, Norwich, UK 6South Western Ambulance Service NHS Foundation Trust, Exeter, UK 7School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, UK Acknowledgements All the authors acknowledge and are grateful for the support of South West Ambulance Service NHS Foundation Trust (and the former Great Western Ambulance Service), the Research Design Service and University Hospitals Bristol NHS Foundation Trust for support in designing and carrying out this study. The authors, and the study design, have benefitted from the help and advice of their patient partners (the Oak Leaves) to whom they are indebted. They acknowledge also the support of the National Institute for Health Research, through the Comprehensive Clinical Research Network. Finally, they would like to acknowledge the help of all those patients who participate in this research.
Funding Information:
Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0711-25070). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Funding Information:
All the authors acknowledge and are grateful for the support of South West Ambulance Service NHS Foundation Trust (and the former Great Western Ambulance Service), the Research Design Service and University Hospitals Bristol NHS Foundation Trust for support in designing and carrying out this study. The authors, and the study design, have benefitted from the help and advice of their patient partners (the Oak Leaves) to whom they are indebted. They acknowledge also the support of the National Institute for Health Research, through the Comprehensive Clinical Research Network. Finally, they would like to acknowledge the help of all those patients who participate in this research. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0711-25070). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Publisher Copyright:
© 2014, BMJ Publishing Group. All rights reserved.
PY - 2014/9/3
Y1 - 2014/9/3
N2 - Introduction - Currently identification, and therefore, management of patients at risk of osteoporotic fracture in the UK is suboptimal. As the majority of patients who fracture have fallen, it follows that people who fall can usefully be targeted in any programme that aims to reduce osteoporotic fracture. Targeting vulnerable patients who are likely to benefit from intervention may help shift the management of fracture prevention into primary care, away from emergency departments. Paramedics who attend to patients who have fallen may be well placed to assess future fracture risk, using the Fracture Risk Assessment Tool (FRAX) and communicate that information directly to general practitioners (GPs).Methods and analysis - This feasibility study takes the form of a pragmatic, randomised controlled trial aimed at exploring and refining issues of study design, recruitment, retention, sample size and acceptability preceding a large-scale study with fracture as the end point. Patients (aged >50) who fall, call an ambulance, are attended by a study paramedic and give verbal consent will be asked FRAX and fall questions. Patients who subsequently formally consent to participation will be randomised to control (usual care) or intervention groups. Intervention will constitute transmission of calculated future fracture risk to the patients’ GP with suitable, evidence-based recommendations for investigation or treatment. 3 months after the index fall, data (proportion of patients in each group undergoing investigation or starting new treatment, quality of life and health economic) will be collected and analysed using descriptive statistics. A nested qualitative study will explore issues of acceptability and study design with patients, paramedics and GPs.Ethics and dissemination - This protocol was approved by NRES Committee South Central Oxford C in October 2012. Research Ethics Committee ref.12/SC/0604. The study findings will be disseminated through peer-reviewed journals, conference presentations and local public events. A publication plan and authorship criteria have been preagreed.Trial registration number - ISRCTN: 36245726
AB - Introduction - Currently identification, and therefore, management of patients at risk of osteoporotic fracture in the UK is suboptimal. As the majority of patients who fracture have fallen, it follows that people who fall can usefully be targeted in any programme that aims to reduce osteoporotic fracture. Targeting vulnerable patients who are likely to benefit from intervention may help shift the management of fracture prevention into primary care, away from emergency departments. Paramedics who attend to patients who have fallen may be well placed to assess future fracture risk, using the Fracture Risk Assessment Tool (FRAX) and communicate that information directly to general practitioners (GPs).Methods and analysis - This feasibility study takes the form of a pragmatic, randomised controlled trial aimed at exploring and refining issues of study design, recruitment, retention, sample size and acceptability preceding a large-scale study with fracture as the end point. Patients (aged >50) who fall, call an ambulance, are attended by a study paramedic and give verbal consent will be asked FRAX and fall questions. Patients who subsequently formally consent to participation will be randomised to control (usual care) or intervention groups. Intervention will constitute transmission of calculated future fracture risk to the patients’ GP with suitable, evidence-based recommendations for investigation or treatment. 3 months after the index fall, data (proportion of patients in each group undergoing investigation or starting new treatment, quality of life and health economic) will be collected and analysed using descriptive statistics. A nested qualitative study will explore issues of acceptability and study design with patients, paramedics and GPs.Ethics and dissemination - This protocol was approved by NRES Committee South Central Oxford C in October 2012. Research Ethics Committee ref.12/SC/0604. The study findings will be disseminated through peer-reviewed journals, conference presentations and local public events. A publication plan and authorship criteria have been preagreed.Trial registration number - ISRCTN: 36245726
KW - Accidental Falls/prevention & control
KW - Allied Health Personnel
KW - Feasibility Studies
KW - General Practice
KW - Humans
KW - Osteoporotic Fractures/epidemiology
KW - Risk Assessment
KW - World Health Organization
UR - http://www.scopus.com/inward/record.url?scp=84929939824&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2014-005744
DO - 10.1136/bmjopen-2014-005744
M3 - Article
C2 - 25186156
SN - 2044-6055
VL - 4
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e005744
ER -