台灣脆弱性骨折聯合照護網絡之發展與建置

Development of Fragility Fracture Liaison Service Network in Taiwan

吳至行(Chih-Hsing Wu) ； 楊榮森(Rong-Sen Yang) ； 蔡克嵩(Keh-Sung Tsai) ； 彭仁奎(Jen-Kuei Peng) ； 洪立維(Li-Wei Hung) ； 陳崇桓(Chung-Hwan Chen) ； 林志學(Chih-Hsueh Lin) ； 牛自健(Chi-Chien Niu) ； 詹鼎正(Ding-Cheng (Derrick) Chan)

《台灣醫學》 22卷2期 (2018/03) Pp. 152-160

https://doi.org/10.6320/FJM.201803_22(2).0006

摘要

台灣髖部骨折的病患中，只有1/4接受骨密度檢測，1/3接受骨鬆藥物治療。推廣「骨折聯合照護服務(fracture liaison service，FLS)」是次級骨鬆骨折預防的有效措施。文獻顯示，FLS可增加骨密度檢測率，骨鬆藥物使用率及遵醫囑性，也能減少再骨折率及死亡率。2014年起，台大醫療照護體系，建立了台灣的第一個骨折聯合照護服務(FLS)，並由台大總院得到國際骨鬆基金會認證金牌獎，北護分院得到銀牌奬。自2016年起，中華民國骨質疏鬆症學會舉辦了3場骨折聯合照護服務(FLS)工作坊，邀請有經驗的服務成員，指導有與趣的醫療院所，成立骨折聯合照護服務(FLS)，最後在全國建立了22個骨折聯合照護服務(FLS)服務據點。其中，在國際骨鬆基金會最佳執業地圖上，至2108年2月，台灣有3個骨折聯合照護服務(FLS)服務據點得到金牌認證，3個銀牌認證，4個審查中，1個正在建立收集資料，2017年在佛羅倫斯舉辦的世界骨，骨關節炎國際會議中，中華民國骨鬆學會得到全球最佳次級骨折預防獎的殊榮。後續，骨鬆學會更主導了亞太區骨折聯合照護服務共識會議，提供骨折聯合照護服務最佳執業藍圖標準之修正建議。綜合過去幾家台灣「骨折聯合照護服務」的資料發現，上述骨鬆評估治療的過程指標，均有明顯進步，而死亡率也明顯下降。台大的資料顯示，個案對個管師及整個服務的滿意度也很高。足見台灣「骨折聯合照護服務」的發展相當蓬勃，值得國內骨鬆醫療照護提昇規畫與醫療給付的參考。

關鍵字

雙能量X光吸收儀 ； 個案管理 ； 再骨折 ； 遵醫囑性 ； 最佳執業藍圖

並列摘要

Among hip fracture suffers in Taiwan, only 1/4 received bone mineral density (BMD) tests, and 1/3 were treated with osteoporosis medications. Fracture Liaison Services (FLS) were promoted as the effective interventions for secondary fracture prevention. Literature review showed that it improved BMD testing rate, osteoporosis mediation initiation rate and medication adherence. It may also decrease re-fracture rate, mortality and was found to be cost-effective. Since 2014, the National Taiwan University Hospital (NTUH) Healthcare System established its FLSs and was accredited as gold (main hospital) and silver (Bei-Hu branch) medal for best practice. To provide mentorship for establishing newer programs, the Taiwanese Osteoporosis Association (TOA) hosted workshops to healthcare organizations who were interested in such programs. From 2016 to 2017, 3 workshops were held with a total of 22 FLS programs established. Among them, 3 gold medals, 3 silver medals were shown on the Best Practice Map with another 4 programs under review, and 1 in progress as of Feb., 2018. The Taiwan FLS network received the best secondary fracture prevention campaign award at the WCO-IOF-ESCEO Florence 2017. In, Oct., 2017, as a leading role, TOA also hosted the Asia-Pacific Fracture Liaison Service Consensus Meeting, in Taipei, Taiwan. The consensus report provides suggestions for IOF to revise the Best Practice Framework Standards for FLS. Data from several FLS programs in Taiwan also demonstrate improvement in osteoporosis care process indicators and possibly mortality. Furthermore, high satisfactions about the FLS programs and coordinators were reported. It was clearly that the FLSs in Taiwan are booming and could be the model for improving quality of osteoporotic care to draw policy changes for reimbursement and clinical practice.

並列關鍵字

DXA ； case management ； re-fracture ； compliance ； best practice framework

參考文獻

Akesson K, Marsh D, Mitchell PJ, et al: Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 2013;24:2135-52.

Boudou L, Gerbay B, Chopin F, et al: Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int 2011;22:2099-106.

Wallace I, Callachand F, Elliott J, et al: An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis. JRSM Short Rep 2011;2:8.

Wu CH, Tu ST, Chang YF, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Osteoporosis and Sarcopenia 2017;2017:S51-2.

Briot K: Fracture liaison services. Curr Opin Rheumatol 2017;29:416-21.